THE SECRET ABOUT BEATING CANCER: IT’S ALL ABOUT TEAMWORK STRETTA: NON-SURGICAL REFLUX TREATMENT IF COLON CANCER RECURS…
2015 •ISSUE:01 YOUR COMPLIMENTARY COPY
THIS WILL REJUVENATE YOU!
TURKEY
IN THE HEART OF TURKEY Liv Hospital in Ankara...
REDUCE YOUR RISK OF BREAST CANCER
HEALTH TO YOUR KNEES!
BREAKING THE CANCER CODE: TREATMENT GETS PERSONAL
FOREWORD
MERİ İSTİROTİ Liv Hospital Group Coordinator
DEAR READERS, Change and Renewal, the Keys to Life... Setting out with the motto ‘Creating a new “Me” from the inside out’, at Liv Hospital we have been a pioneer in medical practice and innovation ever since our foundation. Now, it’s time for fresh innovations ... Stem cell therapy is the most thrilling innovation in medicine right now. Produced from one’s own fat cells as a remedial and regenerative miracle, stem cells are being produced and applied for the first time in Turkey under the roof of a hospital at Liv Hospital, in compliance with all applicable GMP (Good Manufacturing Practice) standards. Actually, the essence of regeneration and renewal is implicit in the human body... Stem cell applications are now used as effective treatments in healing persistent wounds, for anti-aging treatments, knee and cartilage problems, cornea transplants, and various chronic diseases. Stem cells are set to pave the way for a fresh wave of transformations in medicine in the near future. These innovations and our various well-focused affiliations continue to add value to the entire health sector in Turkey as the Liv Hospital group nurtures and develops highly qualified personnel over the whole range of medical competencies... In this context, we have initiated an important affiliation. Our collaboration with Bilgi University School of Health Sciences and Vocational School of Healthcare Services provides education and training that contributes to the development of qualified personnel in the health sector. In addition, we offer opportunities for trainee students to gain experience in their chosen fields. By enabling trainees to put their theoretical knowledge into practice at Liv Hospital, we are helping to create an ever more highly qualified healthcare team. All the journeys we take in life are marked by innovation and transformation, whether personal, scientific or corporate. This is because regeneration and change represent life itself. At Liv Hospital, we believe that every new day is a fresh start for all of us ... Wishing you days full of health and happiness…
“ Setting out with the motto ‘Creating a new “Me” from the inside out’, at Liv Hospital we have been a pioneer in medical practice and innovation ever since our foundation.
CORPORATE NEWS
CONTENTS 2015
LIV HOSPITAL IN ANKARA, THE HEART OF THE TURKEY
48 Surviving Chemotherapy and Radiotherapy
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Liv Hospital in Ankara, the Heart of The Turkey
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Leisure Opportunities You Deserve a Break Too
32 IORT: Single Dose Radiotherapy, During Surgery
34 36
All About Scoliosis Cataract Surgery Without Stitches
37 Cornea Transplants - A Brand New View on Life
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38 This will Rejuvenate You!
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Before It’s Too Late!
66 The Secret about
Health to Your Knees!
54 If Colon Cancer
All You Ever Wanted To Know About Radiological Examinations
64 Take Precautions
Recurs…
56 Reduce Your Risk of
Beating Cancer: It’s All About Teamwork
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Don’t give in to OBESITY!
Breast Cancer
44 Take Good Care of
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Your Joints with Stem Cell Treatments
46 Stretta:
Your Heart is in Safe Hands with Our Cardiac Team
61 The Benefits of
Non-Surgical Reflux Treatment
Endoscopic Surgery
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62
Breaking The Cancer Code: Treatment Gets Personal
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CORPORATE NEWS
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A STEM CELL PRODUCTION CENTER AT Liv HOSPITAL
LIFE NEWS
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THEY TOLD ME “THERE’S NO POINT IN SURGERY“ BUT… Diagnosed late with cancer and told by her doctors that surgery would be pointless, Habibe Delikanlı was treated by Prof. Dr. Oktar Asoğlu and his team.
TEAM WORK
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LICENSE HOLDER ON BEHALF OF Liv HOSPITAL Muharrem USTA NAME OF PUBLICATION Live TYPE OF PUBLICATION Local Periodical MANAGEMENT Liv Hospital Ahmet Adnan Saygun Cad. Canan Sok. No:5 PK: 34340 Ulus, Beşiktaş İstanbul EDITOR IN CHARGE Meri İSTİROTİ EDITORIAL BOARD Prof. Dr. Oktar ASOĞLU Dr. Adil TANIK Dr. Gamze DEMİRTAŞ Mine TUDUK Eylem GÖKALP
DESIGN AND LAYOUT Kollektif Yayıncılık Reklam Tasarım Ve İçerik Hizm. A.Ş. Mat-Set Plaza Yeşilce Mah. Emektar Sok No:5 Kat:4 Kağıthane DIRECTOR Emin GÖRGÜN COORDINATOR OF PUBLICATIONS Aynur ŞENOL ALTUN EDITORS Demet DEMİRKIR Pınar ŞEN ART DIRECTOR Aziz KOCABAŞ GRAPHIC ARTIST Büşra ÖZTÜRK PHOTOGRAPHIC EDITOR Şeref YILMAZ PRINTED BY UNIPRINT Basım San. ve Tic. A.Ş. Ömerli Mah. Hadımköy-İstanbul Cad. No:159 34555 Arnavutköy / İstanbul
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ALL ABOUT SCOLIOSIS
TEL : 0212 798 2840 All rights remain the property of Liv Hospital; quotations may not be made without permission. This publication is for informative purposes.
CONTRIBUTORS
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Assoc. Prof. Dr. ADEM UÇAR
Specialist Dr. AHMET GÜNAY
Prof. Dr. AHMET ÖZKARA
A graduate of Istanbul University Çapa Medical Faculty, Adem Uçar answers our questions on radiologic examinations and recounts efforts to minimize radiation levels with advanced equipment.
A graduate of Istanbul University Cerrahpaşa Medical Faculty, Dermatology Specialist Ahmet Günay contributed to our esthetics file.
A graduate of Istanbul University Çapa Medical Faculty, cardiovascular surgeon Ahmet Özkara tells us about heart operations.
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Prof. Dr. ASENA AKDEMIR
Assoc. Prof. Dr. BARIŞ BAKIR
Dietician BURCU ERDÖL
A graduate of Çukurova University Medical Faculty, Psychiatry Prof. Dr. Asena Akdemir addresses the psychological aspects of the obesity.
A graduate of Istanbul University Çapa Medical Faculty, radiologist Dr. Bakır briefs us on radiologic examinations.
A graduate of Başkent University Department of Nutrition and Dietetics, Burcu Erdöl shares with us her ideas for a weekly diet program.
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58 Assoc. Prof. Dr. ALP BURAK ÇATAKOĞLU A graduate of Istanbul University Cerrahpaşa Medical Faculty, cardiologist Dr. Çatakoğlu draws attention to the importance of teamwork.
28 61 Assoc. Prof. Dr. A. CEM İYİBOZKURT A graduate of Istanbul University Istanbul Medical Faculty, gynecologist and Obstetrics specialist Dr. İyibozkurt explains the advantages of endoscopic surgery.
46 Prof. Dr. CENGIZ PATA A graduate of Hacettepe University Medical Faculty, Gastroenterology Specialist Prof. Dr. Cengiz Pata briefs readers on the ‘stretta technique’ in reflux treatment.
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58 Dr. CENK İNDELEN A graduate of Gazi University Medical Faculty, Dr. İndelen the importance of Liv technology in treating heart disease.
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58 Assoc. Prof. Dr. ENIS OĞUZ
Assoc. Prof. Dr.ÇAĞATAY ÖZTÜRK A graduate of Hacettepe University Medical Faculty Department of Orthopedics and Traumatology, Ass. Prof. Çağatay Öztürk expains scoliosis.
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A graduate of Istanbul University Istanbul Medical Faculty, cardiologist Dr. Oğuz discusses the application of technology in treating heart disease at Liv Hospital.
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Prof. Dr. ERDAL KARAÖZ
Dentist FIRAT DAĞCIOĞLU
Prof. Dr. HALUK ONAT
Doç. Dr. EMRULLAH TAŞINDI
Prof. Dr. Karaöz founded Kocaeli University’s Stem Cell and Gene Therapy Research and Practice Center. In charge of the Liv Hospital Stem Cell Production Center, Prof. Karaöz briefs us on stem cells.
A graduate of Istanbul University Dental Faculty, Fırat Dağcıoğlu briefs us on cosmetic dentistry.
A graduate of Istanbul University Çapa Medical Faculty, Medical Oncology Specialist Prof. Dr. Haluk Onat discusses the breaking of the cancer code and personalization of cancer treatment.
Hacettepe University Ophthalmology Department graduate Assoc. Prof. Emrullah Taşındı, gives information about Femto Cataract.
• JANUARY-JUNE 2015
CONTRIBUTORS
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Assoc. Prof. Dr HASAN ALTUN
Prof. Dr. İSMET ASLAN
Prof. Dr. LEVHI AKIN
A graduate of Hacettepe University Medical Faculty, general surgeon Dr. Altun explains obesity surgery.
A graduate of Istanbul University Medical Faculty, Ear Nose Throat Specialist Dr. Aslan briefs us on voice disorders.
A graduate of Ankara University Medical Faculty, in this issue breast surgery specialist Professor Akın considers risk factors in breast cancer cases.
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Prof. Dr. MURAT AKSOY
Prof. Dr. MUSTAFA KEMAL HAMAMCIOĞU
A graduate of Istanbul University Cerrahpaşa Medical Faculty, general surgeon Professor Aksoy contributed to this issue’s ‘esthetics files’.
A graduate of Ege University, Brain and Nerve Surgeon Prof. Dr. Mustafa Kemal Hamamcıoğlu tells us about brain tumors.
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48 Specialist Dr. MELTEM TOPALGÖKÇELI SELAM A graduate of Istanbul University Istanbul Medical Faculty, medical oncologist Dr. Meltem Topal Gökçeli Selam fills us in on the essentials of the chemotherapy process.
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Prof. Dr. OKTAR ASOĞLU
Dietician SERAP GÜZEL
A graduate of Istanbul University Istanbul Medical Faculty, Liv Hospital Medical Director Professor Asoğlu answers questions about IORT and colon cancer.
A graduate of Hacettepe University Department of Nutrition and Dietetics, Serap Güzel gives key advice on nutrition in diabetic cases.
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Dr. M. REŞAT ARPACI
Prof. Dr. TALAT KIRIŞ
Ass. Prof. Dr. TANER BEKMEZCİ
Dr. Arpacı briefs Live Magazine readers on hair transplantation and who can benefit from it.
A graduate from Istanbul University Medical Faculty, Brain and Nerve Surgeon Prof. Dr. Talat Kırış, explains floresan guided method on brain tumors.
A graduate of Ankara University Medical Faculty, Orthopedics and Traumatology Specialist Ass. Prof. Dr. Taner Bekmezci explained makoplasty surgeries on hip prosthesis.
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32 48 64 Specialist Dr. TAYFUN HANCILAR A graduate of Istanbul University Cerrahpaşa Medical Faculty, radiation oncologist Dr. Tayfun Hancılar gives his recommendations for patients undergoing radiotherapy.
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Doç. Dr. TUĞRUL ALTAN
Assoc. Prof. Dr. UĞUR HAKLAR
Op. Dr. ÜMRAN İLERI
Prof. Dr. VEDAT KAYA
A graduate of İstanbul University Medical School Ophthalmology Specialist Ass. Prof. Tuğrul Altan, briefs us about cataract.
A graduate of Hacettepe University Medical Faculty, orthopedist and traumatologist Dr. Haklar assesses the latest ‘MAKOplasty’ method.
A graduate of Istanbul University Çapa Medical Faculty, plastic, cosmetic and reconstructive surgeon Dr. İleri explains breast implants in breast cancer cases.
A graduate of Ankara University Medical Faculty, ophthalmologist Professor Kaya briefs readers on cornea transplants.
58 Assoc. Prof. Dr. YELDA TAYYARECI A graduate of Istanbul University Çapa Medical Faculty, Dr. Tayyareci tells us about keeping a healthy heart through the winter.
• JANUARY-JUNE 2015
CORPORATE NEWS
Liv HOSPITAL
ANKARA
IN THE HEART OF TURKEY
“ Two years ago the Liv Hospital Group gave the healthcare sector a boost with a massive investment to create the group’s first hospital in Istanbul’s Ulus neighborhood. Now, a further $40 million investment has gone into opening Liv Hospital Ankara. “We are now in Ankara with state-of-the-art hi-tech equipment and a first class team of doctors” says Liv Hospital Group Chairman of the Board Muharrem Usta. 8
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iv HOSPITAL GROUP has accelerated its investment boost to the healthcare sector. The Group gave the Turkish healthcare sector a thoroughly upscale image two years ago with its investment in our flagship Istanbul Ulus facility, which has made its mark with activities ranging from scientific research to advanced diagnostics and therapy, all carried out by a first class team of doctors providing A-plus services. Now, the Group’s second hospital has opered Ankara, the nation’s capital city. The result of a $40 million investment program, Liv Hospital Ankara is located at Tunus Avenue in Ankara’s upscale Çankaya district. The hospital provides healthcare services across all medical fields in a series of specialized clinics with 150 beds and 8 operating theaters in an indoor area of 27 thousand square meters. The hospital is set to make a real difference in Ankara, with numerous clinics and treatment methods focusing on cancer surgery, adult and pediatric healthcare, and eye healthcare issues. INSPIRED BY THE HUMAN BODY The underlying design inspiration for Liv Hospital Ankara is the human body’s self healing capacity. With a purist floor plan based on fluid structures avoiding sharp angles just like the human body, Liv Hospital Ankara has been designed and decorated to evoke the clockwork-like workings of the body. Interior designers have worked to give patients all the comforts and feelings of a home away from home. Based on Liv’s trademark multidisciplinary approach designed to achieve seamless collaboration between different clinics and physicians, all diagnostic and treatment procedures are carried out on ‘360 degree’ principles. Liv Hospital Ankara is dedicated to a patient-focused approach put into practice by experienced doctors and healthcare professionals imbued with our multidisciplinary philosophy. In short, Liv Hospital Ankara gives the entire healthcare sector in Turkey a new-generation interpretation.
Liv Hospital is located right in the heart of Ankara, directly opposite the Parliament building
CORPORATE NEWS
A
A STEM CELL PRODUCTION CENTER AT Liv HOSPITAL
FIRST FOR TURKEY Turkey’s first in-hospital Stem Cell Production Center operating in line with international GMP standards has opened for service at Liv Hospital. Head of Liv Hospital Regenerative Medicine and Stem Cell Production Center / Liv MedCell Prof. Dr. Erdal Karaöz, Specialist in Dermatology Prof. Dr. Gonca Gökdemir and Specialist in Cosmetic, Plastic and Reconstructive Surgery Op. Dr. Ümran İleri were on hand at a press conference to answer questions.
THE SOLUTION IS WITHIN YOUR OWN BODY! Pointing out that stem cells were the most exciting innovation in medicine in recent years, Liv Hospital Group Coordinator Meri İstiroti said “Stem cells represent a miracle produced from your own fat cells; stem cells are being produced and applied for the first time in Turkey under the roof of a hospital at Liv Hospital, in compliance with all applicable GMP standards. Actually the essence of recovery and renewal are hidden within the mysteries of the body. Stem cell applications can be used as effective treatments in cases of persistent wounds, anti-age10
ing, knee and cartilage problems, cornea transplants and a number of chronic diseases. As a result, they will very soon open the way to rapid transformations in the medical field. From the very first day, Liv Hospital has had a mission to keep a close eye on innovations in medicine and to add to the pool of scientific knowledge in the international arena.”
CELL- AND TISSUEBASED NEW GENERATION TREATMENT OPTIONS Head of Liv Hospital Regenerative Medicine and Stem Cell Production Center / Liv MedCell Prof. Dr. Erdal Karaöz went on to explain “As an institution, we have a strong belief in the importance of inter-disciplinary cooperation in this field, which incorporates all branches of medical and life sciences. Having set out on this journey together with scientists and physicians who are making significant contributions to the universal store of scientific knowledge in our country, we are dedicated to providing our patients with cell – stem cell – tissue engineering and authorized treatment options in the field of gene therapy, in strict conformity with all scientific and ethical rules.”
FRIENDSHIP ACROSS DISCIPLINES AND BORDERS
Doctors and nurses from around the world enjoyed the opportunity to experience the technology at Liv Hospital at first hand.
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iv HOSPITAL hosted 23 doctors and 6 nurses from around the world. Doctors and nurses from Iran, Georgia, Macedonia, Kosova, Kazakhstan and Austria exchanged news and views and witnessed the experience, knowledge and technology used by their colleagues at Liv Hospital.
PRAISE FROM MACEDONIA: DR. IVAN EFTIMOV ADMIRES Liv’S TECHNOLOGY Macedonian Specialist in Orthopedics Dr. Ivan Eftimov came to Liv Hospital under the aegis of a project initiated by the government of Macedonia. Explaining that he had chosen Liv Hospital in the context of Turkey’s recent achievements and advances in the medical field, Dr. Ivan Eftimov continued “The hospital has created a lasting impression on me ever since I came through the doors. Liv Hospital has a large orthopedic team. Therefore I have spent every day to the fullest. I came here already aware of the fact that Liv Hospital is the only hospital in the region with new technologies like MAKOplasty, and now I have had the chance to experience it at first hand.” Dr. Eftimov expressed his thanks to Assoc. Prof. Dr. Ayhan Kılıç, Assoc. Prof. Dr. Uğur
Haklar, Surgeon Dr. Taner Bekmezci and Surgeon Dr. Egemen Ayhan.
that he would make a point of visiting Liv Hospital again.
“Liv HOSPITAL SHOWED US THE MEANING OF INNOVATION”
EUROPEAN MEDICAL STUDENT SELECTS Liv HOSPITAL FOR INTERNSHIP
Nadeja Cidalova, Natasha Kanevçe, Valentina Toshevska and Daniella Yakimoska came on a two-week exploratory visit to Liv Hospital from different places. Describing how they had been impressed, the nurses said they had been delighted by the assistance they had received from doctors and members of staff.
Christian Müller performed a one-month internship in the departments of general surgery, cardiovascular surgery and plastic surgery. During his internship he had the opportunity to observe DaVinci Robotic Surgery up close, as well as technology such as MAKOplasty Robotic Surgery and TrueBeam that only Liv has in Turkey.
HIGH PRAISE FROM AN ITALIAN SURGEON Italian surgeon Guiseppe Polizzotti visited Liv Hospital on the recommendation of colleagues in Italy. Meeting Liv Hospital Medical Director and Specialist in General Surgery Prof. Dr. Oktar Asoğlu and Surgeon Dr. Adil Tanık, Guiseppe Polizzotti said “I have seen many wonderful things at Liv Hospital, and met patients suffering from different complaints.” Recounting his initial hesitations over the fact that Liv Hospital was such a new institution, Dr. Polizzotti said that the moment he entered the hospital he felt he was in another world. He confirmed
THE HEALTHCARE SECTOR GETS TOGETHER IN ANKARA
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ddressing a panel attended by representatives from the public sector as well as private hospital executives, Liv Hospital Group Coordinator Meri İstiroti stressed that health tourism had undergone very significant developments in Turkey. “The establishment of the Ankara Health Tourism Association is a major step forward in the wake of
the starting up of similar associations in Antalya, Adana and Bursa together with new investments in the sector. Ankara is crucial in terms of its prices and scientific output. In addition, its infrastructure is excellent. We need to attract health tourism to Ankara by prioritizing patients’ historic and cultural values in the context of deficiencies in neighboring countries’ services and technology,” she said. Liv Hospital Group Coordinator Meri İstiroti stated that the Liv Hospital Group had so far admitted patients from 112 countries and become a key player in this sector.
CORPORATE NEWS
TOP AWARD FOR Liv HOSPITAL FROM NEIGHBOUR GREECE
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ust two years after opening its doors with the aim of becoming a leading healthcare institution in the international arena, Liv Hospital has been honored with an award that carries special meaning, coming as it does from neighboring country Greece. A Commission of the Greek Ministry of Health and the Greek Health Tourism Organization has seen fit to recognize Liv Hospital with its award for ‘Innovative Approaches in Healthcare and Contributions to Health Tourism.’
ing outstanding scientific medical results, firstly through sound operational management and then with a team of accomplished specialists and experts backed with the latest technology. As Liv Hospital, our unwavering belief and commitment to teamwork has allowed us to make remarkably rapid progress. The cooperation between Turkey and Greece that has proved impossible in the Eurovision Song Contest over so many years has now been accomplished in healthcare”.
‘FIRST’ FOR A TURKISH HOSPITAL
DIFFICULT CASES AND HIGH LEVEL MEDICAL SERVICES
Held at the Royal Olympic Hotel in Athens, the awards ceremony was attended by representatives from prestigious hospitals and healthcare bodies around the world, health tourism agencies, and leading health tourism association members. Liv Hospital Group Coordinator Meri İstiroti accepted the award, the first of its kind to be bestowed on a hospital from Turkey, on behalf of the Liv Hospital family.
“BACKING OUR SPECIALIST TEAMS WITH TECHNOLOGY” Stating that the Liv Hospital Group were proud to be the first Turkish healthcare institution to receive the Greek Ministry of Health and Health Tourism Commission’s award, Meri İstiroti continued “The only real way to differentiate oneself in the healthcare sector is by achiev12
Determined by a commission established by officials of the Greek Ministry of Health and the Greece Health Tourism Organization to evaluate hospitals from various countries, the award has been bestowed on a healthcare institution from Turkey for the very first time. The Greek delegation, who had recently visited Liv Hospital to evaluate its innovative healthcare practices, were impressed by Liv Hospital’s distinctive approach to marketing and management. Their detailed evaluation centered on Liv Hospital’s branding process, its ground-breaking international marketing methods, its highlighting of difficult cases and medical services with high level medical issues, as well as its operational infrastructure. The ceremony was attended by hospitals and healthcare institutions from Germany, Cyprus, UK, Spain and France.
IN HEALTH, A GATEWAY TO THE WORLD:
International Patient Department W ITH AN IMPRESSIVE repertoire of 26 languages, Liv Hospital’s specially trained team of international patient recovery assistants makes our overseas patients and their loved ones feel right at home. Briefing us about Liv Hospital’s comprehensive range of international healthcare services, International Marketing Manager Hasan Arslanyüreği explains that the team, which itself represents a cultural mosaic, is always sensitive to cultural norms and expectations in providing a welcoming and hospitable environment to guests from around the world. Liv Hospital provides patients far from their home countries with a wide range of interpretation, medical, social and ancillary services in their own language, throughout the diagnosis, treatment and recovery process. A team ready to assist international patients is on hand at Liv Hospital 24 / 7. In short, patients have the constant support of a friendly group of people from
A to Z, just as if they were with friends from home. Our International Department addresses all patients’ requests and desires, from visa processes to city tours and arranging accommodation for their families and loved ones; patients and guests are even picked up and dropped off wherever they wish to go by the hospital’s dedicated private vehicles.
AIMING TO BE A REGIONAL REFERENCE CENTER Liv Hospital’s primary objective is to become a true reference center for healthcare in the region by means of giving prominence to what makes Liv unique. In summary, our combination of the best physicians working closely together with Liv Hospital’s celebrated multidisciplinary model, the latest technology and methods of treatment, together with our capacity to generate and publish medical data, allow us to compete with the world’s leading medical centers.
CORPORATE NEWS
Extending The Hand Of Health To The Balkans:
THE Liv HOSPITAL MOBILE CLINIC By touring 18 provinces of 3 different countries in 18 days with our mobile clinic, Liv Hospitals and our medical services were intruduced to the Balkans.
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he Liv Hospital Mobile Clinic’s first stop on its Balkan whistle-stop tour was Bosnia-Herzegovina. Fully equipped and ready to receive patients, the Liv Hospital Mobile Clinic continued its journey after Bosnia Herzegovina to Kosovo. The Clinic and its team of specially trained medical experts drew great attention throughout its progress in the Balkans, serving also to bolster relations with a number of states in the region. Liv Hospital is proud to have been organized an important social responsi-
bility project, allowing Liv to spread its accumulated wealth of experience and medical capacities to the Balkans. Having forged many lasting friendships along its long journey, the Mobile Clinic team provided both diagnostic and therapeutic preventive healthcare measures. In total, Liv Hospital is delighted to have been able to convey its team of 7 doctors and 12 ancillary staff to the Balkans, where no less than 950 patients benefitted from the Mobile Clinic’s services in addition to 4,800 patient visits.
Our team is always ready to hold out a helping hand
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We made good friends along the way.
Congratulations to the bride and groom we met in Kosovo.
We managed to catch the eye of many people
Our clinic up and running under the statue of Iskender Bey, in the capital of Kosovo
people of all ages gathered together.
CORPORATE NEWS
Famous Romanian popstar Dorian Popa
“AGAINST DARK, AGAINST CANCER� CHARITY CONCERT IN ROMANIA
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This year, Santa Claus was at the organization to help Liv Hospital
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very year, more than 7.000 Romanians travel to Turkey seeking medical treatment and consultation. On the longest night of the year, 21st of December 2014, famous entertainers came together with Liv Hospital in Bucharest, Romania to support children with cancer. This was the first time a Turkish medical institution organized such an event on Romanian soil. Many celebrated singers, rappers and dancers performed on stage, entertaining approximately 400 children and a total of over 10,000 attendees. The event organized by Liv Hospital was not only a major success in fund-raising, but also a great motivation for the children and their families. The donations were collected by the P.A.V.E.L. association, which is a Romanian non-profit organization of parents of children with cancer.
Liv HOSPITAL IN THE WORLD ARENA WITH JCI Liv Hospital has broken world records in its rapid and Livflawless Hospital accreditation by Joint General Manager Meri İstirotiCommission was International presented with (JCI), the world’s leading JCI accreditation by JCI officials authority in the field of medical at a special ceremony. accreditation.
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HE IDEA of gaining JCI accreditation was born while Liv Hospital was still on the drawing board. The founders together with a dedicated quality control team rapidly began work to this end. Experts in this field together with healthcare professionals and the administrative staff set the hospital’s objective to become a reference point in healthcare services, technology and guest accommodation, right from the
moment the hospital opened its doors on January 7th. JCI members traveled from Chicago to spend about a week auditing and inspecting the hospital in line with strict JCI criteria, returning to the States to report their findings to their Board. The organization’s accreditation adds further value to our hospital, which maintains the highest quality standards and objectives in the field of international healthcare services.
WORLD CLASS QUALITY AT Liv WITH TUV
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SO IS THE ACRONYM of the International Organization for Standardization, an independent, universally recognized organization and the world’s largest developer of voluntary International Standards; its stamp represents acceptance of an organization’s standards of quality in products or services. Liv Hospital underwent the rigorous TUV accreditation process just four months after opening. The Hospital emerged successfully from the “Audit” process one month later. ISO 9001 Quality Management System accreditation gives organizations the quality systems that provide them with the foundation to better customer satisfaction, staff motivation and continual improvement. The process encompasses the entire organization; to achieve ISO 9001 certification the organization needs to demonstrate that it can meet the regulatory requirements and apply the system effectively to be of real benefit to its customers. The system is effectively implemented at Liv Hospital, ensuring high levels of customer satisfaction; Liv Hospital regards ISO 9001 standards as the minimum condition required for the conduct and operation of a first class institution such as Liv Hospital.
CORPORATE NEWS
INTERNS FROM AROUND THE WORLD AT Liv
From the professional point of view, Liv Hospital’s doctors have really impressed me with the rapid and results-oriented solutions they achieve thanks to Liv Hospital’s 360 degree patient-centered approach.
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Y NAME IS Nikolay Belimenko, I’m a doctor from Ukraine. I came to Liv Hospital for a practical study. What can I say about this hospital? First of all I want to say that I have just positive emotions and mentions. From the first day I felt myself so comfortable and I didn’t have any problems. Shortly about Liv Hospital; Liv Hospital has a very high quality team, doctors and equipment, which commonly helps people from different contries and regions. They have very good medical diagnostic
and treatment, which is the most important thing, that should be. I want to say a little about the department of cardiology, where I had my training. This is a very Professional team, and who do their best to help patients. I want to say thanks to; Dr Alp, Dr.Murat, Dr. Enis, Dr. Elda, Dr.Ahmet and other personel of this team for helping me to improve my experience. And also I want to say thanks to the senior management for giving me the opportunity to have a training in such a great hospital.
MACEDONIAN MINISTRY OF HEALTH NURSES VISIT LIV HOSPITAL – MARCH 2015
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ETWEEN the 2nd and 19th of March, a group of Macedonian nurses were accepted for an educational program by Liv Hospital Ulus, Patient Care Services. The group of 8 nurses and technicians completed their course through in-class training and clinical observations on the field, with attendees from various Macedonian public hospitals. At the end of the 17 day course, program participation certificates were given to the group of nurses. ✓ A wonderful work environment and a brilliant team, we would like to thank everyone for their support. ✓ Excellent staff, the hospital is amazing. Thank you for your hospitality. ✓ It was a great experience for us, what an amazing hospital! Thank you for everything. 18
✓ An amazing hospital and an amazing staff. Thank you so much for your hospitality. ✓ I learned a lot of things during the time I spent at the hospital, the time flew by, three excellent weeks at an amazing hospital. The staff is great. ✓ An amazing hospital. Perfect Doctor/Nurse – Patient communication. The technology being used and the whole staff are great. I am going to suggest Liv to everyone who needs help. ✓ We would like to thank the hospital and the staff fort his great service they provided. We would also like to thank the head nurses and Mr. Yaşar for their support. ✓ I’m very happy to be at this amazing hospital. I hope to work at a hospital like this one day. I would like to thank Mr. Yaşar for his support.
SCIENTIFIC EVENTS
ADVANCED CARDIOVASCULAR SOLUTIONS
Another ‘First’ in Turkey... Google Glass technology gives a Turkish doctor’s bird’s eye view to a colleague in Japan …
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he most noteworthy aspect of the symposium held at Bilgi University was a live “difficult coronary vessel stenting” case. Google Glass technology was employed for the first time in Turkey in such a context. The conference was attended by 170 participants from throughout Turkey as well as 40 cardiologists from abroad. The ACS (Advanced Cardiovascular Solutions) Symposium’s main sponsor was TİKA (the Turkish Cooperation and Coordination Agency), noted for its remarkable work in representing Turkey at international forums. TİKA scored a major success in sponsoring the ACS symposium, which drew such significant attendance from physicians from around the world. The ACS 2014 Symposium attracted 36 cardiovascular surgeons and specialists from ten countries – Kosovo, Albania, Georgia, Yemen, Macedonia, Sudan, Turkmenistan, Uzbekistan, Kirgizstan and Moldova. Performed at Liv Hospital, the live case was transmitted directly to cardiology doctors in Japan and to observers at the conference hall in Istanbul by means of Google Glass technology attached to glasses worn by Liv Hospital Cardiology Specialist Associate Professor Dr. Alp Burak Çatakoğlu, while simultaneous medical consultation was provided - from Japan. Thanks to this tele-medicine application of Google Glass, a doctor at a remote location had exactly the same view as the doctor carrying out the procedure. The procedure was watched live by symposium observers as well as the doctors in Japan.
LIVE INSERTION OF A SOLUBLE STENT During the ACS 2014 Symposium’s allday scientific session at Bilgi University, Liv Hospital Cardiology Specialist Associ-
ate Professor Dr. Alp Burak Çatakoğlu performed the soluble stent insertion procedure at Liv Hospital Ulus wearing Google Glass technology during a live broadcast.
A TELE-MEDICINE APPLICATION FOR GOOGLE GLASS The difficult live case procedure was carried out at Liv Hospital by Cardiology Specialist Associate Professor Dr. Alp Burak Çatakoğlu, accompanied by colleagues from Hungary. The procedure was broadcast on a direct live link to Japan. Google Glass technology with the capacity to obtain and record HD video and still images was used; internet connectivity means that images shot with Google Glass can be transmitted anywhere in the world. This feature makes the technology eminently adaptable to tele-medicine applications. The symposium witnessed exactly such an application.
in coronary artery angioma cases were considered during the second session. Technical details in bifurcation stenting constituted the topic of the third session, following the Google Glass-accompanied procedure. The fourth session was devoted to new perspectives on aortic and mitral valve treatments.
IN COLLABORATION WITH THE TURKISH CARDIOLOGY ASSOCIATION The Advanced Cardiovascular Solution 2014 Symposium organized jointly by Liv Hospital and the Turkish Cardiology Association examined a wide variety of issues including soluble stents, mitral valve repair, aortic valves and arrhythmia. The ACS 2014 Symposium was held at sessions that were open to the public at Liv Hospital Bilgi University’s Santral Istanbul Campus.
INTERNATIONAL PARTICIPATION A FOUR-SESSION SYMPOSIUM The first session was devoted to interventional cardiology. Techniques, new medications and devices used in cases of obstructive clots in patients with vascular infarction were discussed during the session. Various imaging methods used
The program gathered together prominent cardiologists and cardiovascular surgeons from Turkey and abroad in 4 separate all-day sessions that incorporated 21 interactive presentations and 2 live cases. The symposium was addressed by a total of 34 guest speakers.
SCIENTIFIC EVENTS
Liv HOSPITAL AND MEMORIAL - SLOAN KETTERING COOPERATION The first of Liv Hospital and Memorial Sloan-Kettering Cancer Center’s collaborative symposium “Personal Approach in Colorectal Cancer Symposium” continued with “Currect Surgical Approacheshes to Thyroid Cancer and Individual Treatment Approaches to Breast Cancer Symposium”. While the doctors-only session held at Liv Hospital, considered diagnostic, treatment and surgical methods in breast and thyroid cancer cases, the public sessions were an opportunity for public members to benefit from Q&A gathering. . OMING TOGETHER for the second time for their to lateral neck procedures, ways to prevent complications in
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joint ‘Current Surgical Approaches to Thyroid Cancer and Individual Treatment Approaches to Breast Cancer Symposium’, Liv Hospital and world-famous cancer center MSKCC gathered together doctors from Turkey and around the world. The public session held was an opportunity for members of the public to benefit from a Q&A session. The doctors-only sessions considered diagnostic, treatment and surgical methods in breast and thyroid cancer cases.
A WEALTH OF KNOWLEDGE A total of 450 Physicians attended two symposiums mskcc + Liv hospıtal on Current Surgical Approaches to Thyroid Cancer and Personalized Treatment Approaches in Breast Cancer, and colorectal cancers from Turkey and 36 from abroad.Amongst the topics up for discussion at the ‘Current Surgical Approaches to Thyroid Cancer’ session were the development of thyroid cancer treatments, current approaches 20
primary and secondary thyroid cancer surgical interventions and the contribution of nerve monitorization, post-operative treatment methods in differentiated thyroid cancer cases, approaches to the treatment of recurrences of thyroid cancer in the neck, and the contribution of new targeted agents to treatment. MSKCC’s Dr. Ashok R. Shaha shared his knowledge on the latest developments in breast cancer treatment and new methods of treatment. At the session on ‘Personalized Treatment Approaches in Breast Cancer Cases’, MSKCC’s Breast Surgeon Dr. Hiram S. Cody shared the latest developments in breast cancer and new therapies with his colleagues. The main issues discussed included quality assurance in breast cancer screening and healthcare services, current applications in breast cancer screening, early treatment of breast cancer, local breast cancer treatment, post-mastectomy radiation therapy and breast reconstruction, and the treatment of metastatic breast cancer.
PROF. DR. OKTAR ASOĞLU Liv Hospital Specialist İn General Surgery
“About 400 foreign and Turkish participants attended the first of the ‘Scientific Meetings’ held as part of our cancer center’s collaboration with MSKCC between 31st January and 1st February 2014 on ‘Personalized Approaches to Colorectal Cancer Patients’. The second meeting on ‘Current Surgical Approaches to Thyroid Cancer and Personalized Breast Cancer Treatment’ held on 12th and 13th September 2014 drew about 200 participants. MSKCC’s head of department Murray F. Brennan, head of their colorectal surgery department Julio Garcia-Aguilar, medical oncologist Andrea Cercek, head of their breast cancer department Hiram S. Cody, the head of MSKCC’s neck and head cancer department Ashok R. Shaha and their chief plastic surgeon Peter G. Cordeiro not only reviewed current developments with their Turkish colleagues, but also played a significant role in raising patient and public awareness in sessions that were open to the public and covered by the media. Liv Hospital is well ahead of the field in Turkey in cancer treatment both in terms of our technological infrastructure (robotic surgery, IORT) and the quality of our team of doctors; we are and shall continue to make a difference with our international affiliations. As well as really putting multidisciplinary working philosophies into practice, Liv Hospital has become a truly exceptional healthcare institution when we compare medical results with international organizations, and we aim to maintain and strengthen that position as we observe these criteria in domestic and international platforms. With a record of successfully treating difficult cancer cases, Liv Hospital is proud to have joined the ranks of the top hospitals not only in Turkey but internationally - even after a short history of just 21 months”.
PROF. DR. LEVHI AKIN Liv Hospital Specialist in Breast Surgery and General Surgery
“The symposium has enjoyed very positive feedback both for its scientific level and its organization, receiving praise for its choice of topics, planning and implementation. The success of the symposium is the result not of individual but team work. This all serves to refine our objective of developing a Liv Hospital culture based on prioritizing ethics, scientific studies, a holistic approach to patients, the unhesitating publication of product outcomes, peer comparison, and a multidisciplinary work philosophy”.
ASSOC. DR. FATIH TUNCA Liv Hospital Specialist in Thyroid Cancer and General Surgery
“A number of home-grown scientists who have devoted themselves to endocrine surgery were joined by one of MSKCC’s most experienced surgeons in this field, Professor Ashok R. Shaha, in sharing their accumulated knowledge and experience. I feel honored and delighted that we hosted a meeting that added such value in terms of its scientific content as well as giving us the opportunity to follow with enthusiasm the latest approaches to thyroid cancer surgery, which after all constitutes such a major part of the field of general surgery in this country”.
IORT SYMPOSIUM FROM LIV HOSPITAL AND MEMORIAL SLOAN KETTERING CANCER CENTER Liv Hospital has joined forces with the world renowned Memorial Sloan Kettering Cancer Center to present our fourth joint symposium on cancer, the disease of our age. The Intra-operative Radiotherapy (IORT) in Cancer Treatment Symposium to be held on 6th June 2015, will be attended by participants from Turkey and around the world. The event is set to adopt the webcast concept, being broadcast on the web directly from Liv Hospital. Hosted by Liv Hospital Specialist in General Surgery Prof. Dr. Oktar Asoğlu, the symposium will be addressed by two prominent speakers from MSKCC, Professors Kaled M. Alektiar and Philip Patty. The occasion, to be held at Liv Hospital, will continue from 08:45 to 18:00.
PROFESSOR HIRAM S. CODY Memorial Sloan Kettering Cancer Center Breast Surgeon
“It has been wonderful to be here. I think the organization picked a great choice of topics, one of the most interesting of all the subjects that needs to be discussed in the field of breast cancer. There are a number of technologic developments in breast cancer. Much has changed in surgical interventions, radiotherapy and chemotherapy. And there is much to talk about on all these subjects”.
With the participation of physicians and healthcare experts from around the world, the symposium will be broadcast live to the accompaniment of simultaneous English translation. Participants will have the opportunity to get answers on issues of concern during the broadcast session. You will be also able to follow the symposium, which will subject the singledose IORT technology that is applied during surgery especially in cases of recurring cancers of the digestive system to a detailed examination, live on www. livcancercenter.com There will also be an open session on Friday 5th June at which members of the public can address any queries about IORT to specialist physicians. REGISTRATION: Mrs. BURÇIN ÖZTÜRK – +90 530 174 4214 – burcin.ozturk@livhospital.com.tr
SCIENTIFIC NEWS
A DUAL PURPOSE CONGRESS – SYMPOSIUM, AND SURGICAL EVALUATION
CARDIOLOGISTS FROM 11 COUNTRIES GET TOGETHER AT Liv T HE 8TH MIDDLE East Cardiovascular Congress has been held at Liv Hospital Conference Hall, attended by heart surgeons and cardiologists from around the world. Jointly organized by Liv Hospital, the Middle East Cardiovascular Foundation and Shiraz University, the Congress covered cardiologic interventions and the latest advances in heart surgery. Amongst the 150 participants were leaders in the field from 11 countries including the US, Iran, Libya, Egypt, and Qatar, as well as Turkish attendees. 30 speakers from Turkey and abroad addressed the Congress, including Professor Navin C. Nanda, known as the father of 3-D cardiography, and Liv Hospital’s Cardiology Specialist Assoc. Prof. Dr. Yelda 22
Tayyareci, who gave a practical ECG demonstration.
PRACTICAL DEMO OF 3-D ECHOCARDIOGRAPHY FROM PROF. NANDA In his address, Prof. Navin C. Nanda stated “You really can see a 3-D image using 3-D echocardiography. Everything in the image is shown in 3-D. In 2-D echocardiography you can only see one side. Therefore you cannot miss a single flaw using 3-D echocardiography. 3-D echocardiography ensures the detection of every disorder, including all arrhythmia, which is a major advance in preventing incidences of sudden death. Prof. Nanda also gave detailed briefings on cardiac function issues. The technology detects valve defects of all kinds.”
Turkish and international cardiologists and surgeons attending the 8th Middle East Cardiovascular Congress also took part in the separate ECHO evaluation of 51 year old Abdülcabbar Elma, who had undergone surgery two days before the symposium. Heart surgery was carried out on the patient during the symposium. Mr. Elma had suffered severe heart failure relating to the detachment of the ligaments holding the mitral valve; Specialists in Cardiovascular Surgery Assoc. Prof. Dr. Ahmet Özkara and Op. Dr. Cenk İndelen performed the intervention. Assoc. Prof. Dr. Ahmet Özkara explained “We carried out a repair without damaging the valve. The heart functioned well under ECHO monitoring during the operation. A cauterization procedure known as ablation was performed at the same session, for arrhythmia. The patient was discharged early after intensive care unit monitoring and a short period of hospitalization. A live ECHO demonstration was given by Congress participant Prof. Navin C. Nanda and the patient was evaluated. “The measurements taken showed that the patient’s heart valve was functioning well and that the repair had been successfully accomplished,” he said.
Liv Hospital Holds First Robotic Surgery Course A live robotic surgery course has been held in cooperation between Liv Hospital and the Turkish Colorectal Surgery Association. Within the scope of the course, two live operations were carried out and simultaneously shared with participants.
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HE TURKISH COLORECTAL Surgery Association’s 1st Robotic Surgery Course was held in the Liv Hospital Conference Hall on 15th December. The history and current status of robotic surgery was explained during the first session. Following the opening session, doctors discussed basic
concepts, following which the live surgery procedure took place. The meeting continued with live interactive connection with the doctors in the hall throughout the Da Vinci operation performed by Prof. Dr. Oktar Asoğlu. After the second operation, the course concluded with an assessment and evaluation session.
Endocrinology Symposium The laboratory plays a crucial role in the diagnosis and monitoring of endocrinologic diseases. However, problems can arise due to technical factors or a lack of information.
Molecular Oncology Conference At the conference, information was shared on BRCA & prognostic molecular testing for breast cancer.
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n 15th November, Liv Hospital hosted a conference on “Molecular Oncology in Personalized Treatment”. The morning session covered the BRCA gene test that uses DNA analysis to identify patients with mutations in the BRCA breast cancer susceptibility genes, who face a much higher risk of developing breast cancer. The session was addressed by Professors Handan Kaya, Nil Molinas Mandel, Gül Başaran, Dr. Meltem Topalgökçeli Selam, and Ass. Assoc. Prof. Dr. Ajlan Atasoy under the chairmanship of Prof. Dr. Faruk Aykan. Dr. Atasoy addressed the conference on prognostic molecular testing for breast cancer. Professors Faruk Aykan, Ümit İnce, Şuayip Yalçın and Gökhan Demir lead participation in the conference’s second session.
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symposium designed to examine these issues, explain endocrinologic perspectives and enhance inter-disciplinary communication entitled “The Laboratory in Endocrinology: What are the pre-analytic – analytic problems? How should results be interpreted?” was held on 20th December 2014 at Liv Hospital Ulus, Istanbul. The two-session symposium hosted by Assoc. Prof. Dr. Serpil Salman discussed issues such as laboratory evaluations of the pituitary gland, thyroid and diabetes cases. The symposium was attended by family doctors, and specialists in internal diseases and endocrinology.
LIFE NEWS
DUTCH CAPTAIN BROUGHT BACK TO LIFE AT Liv HOSPITAL Liv Hospital Medical Director and Specialist in General Surgery Prof. Dr. Oktar Asoğlu carried out emergency surgery to remove a two meter section of Dutch Captain Andre J. Van Schoonhoven’s infected intestine.
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utchman Andrew J. Van Schoonhoven had been captain of the 1,200-person ‘Prinsendam’ on the round journey from Piraeus to Mikonos, Kuşadası, Cyprus and back for the past 5 years when he was struck by a one-in-a-million intestinal blockage at sea. On the advice of doctors in Çanakkale he anchored in Istanbul and was admitted to Liv Hospital.
‘LIKE A SCI-FI MOVIE’ Schoonhoven’s stomach became more and more bloated every day. When the swelling reached such an extent that he was unable to put on his socks in the morning, the ship docked in Istanbul on the advice of the ship’s doctor and he was rushed to hospital. Essential examinations and tests revealed an intestinal 24
blockage. General Surgeon Prof. Dr. Oktar Asoğlu and his team rushed Schoonhoven to the operating theater where they took just ten minutes to remove the 2 meter infected section of his intestine. After 2 days in intensive care and with follow-up tests proving negative for cancer, Schoonhoven recounted his experience: “My stomach started to swell up before I even had time to grasp what was going on. At first I thought it was flatulence. I didn’t give it much thought. I realized something was seriously wrong when I felt so bad I couldn’t get out of bed in the morning. Turkey was a great chance for me. Both my tests and the surgery I had were carried out meticulously. I felt like I was in some sci-fi movie. I am really grateful to Professor Asoğlu and Liv Hospital.”
A HEALTHY HOMECOMING TO BULGARIA Ailing 74 year old Rumen Peychev came to Turkey from Bulgaria to recover his health. As well as suffering various complications as a result of bladder cancer, Peychev had cirrhotic liver, diabetes, high blood pressure coupled with problems with his heart and lungs. Tumors were discovered on both his kidneys during surgery for bladder cancer about seven months ago. Explaining that doctors in Bulgaria had recommended Liv Hospital, Peychev’s wife said “If he had been operated on in Bulgaria he would have stayed in hospital for 10 – 15 days. We contacted Liv Hospital and got a very rapid response. We saw there were treatment options that were not available in Bulgaria. The 15 day hospitalization period in Bulgaria was reduced to just 5 days here. Yes, the surgery carried certain risks but we did not encounter anything negative. So we are thrilled. We are very happy with Liv Hospital. We have never seen such a technologically well equipped hospital.”
Liv’S HELPING HAND TO KAZAKHSTAN
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t the age of 11, Kristina Kryajeuskaya, now 17 and living in Kazakhstan, went to rescue a puppy who had escaped into an electricity sub-station. As she was helping the puppy she received an electric shock severe enough to damage both her hands and shoulder region. In spite of surgery to rescue her hands they could not be saved while adhesions in her shoulder prevented her from being able to lift her left arm. With two prosthetic hands, Kryajeuskaya traveled to Germany twice and received five operations within a period of three months. Referred to Liv Hospital by a friend, Kryajeuskaya says “I came to Turkey dreaming of getting a new shoulder. Now I can lift my left arm. And the scars are disappearing.” Liv Hospital Plastic, Reconstructive and Cosmetic Surgeon Dr. Ümran İleri explains “Kryajeuskaya was admitted with deep scarring and immobility in her left arm. We have reduced the extent of scarring by 50% and restored movement to her left arm. Our objective now is to reduce the remaining scarring to a more tolerable level. Skin taken from her feet was used for her lost hands. We have begun laser treatment to reduce the scarring on her feet.”
A DIFFICULT CASE SUCCESSFULLY TREATED Treatment alternatives were discussed with Peychev, who was struggling with a number of additional health issues. Explaining that they had carried out a Robotic Partial Nephrectomy, Liv Hospital urology specialist Assoc. Prof. Dr. Haluk Akpınar stated “This high-risk patient’s surgery went very well. We removed the cancerous part of his kidneys and sewed up the region using keyhole surgery techniques without the need for open surgery. We used special methods to block bleeding and performed a bloodless operation. We mobilized the patient the same evening and he began to eat the next day. The success of a very major operation is down to superb materials, the quality of the operating theater, our team, an experienced surgeon, and great overall hospital healthcare services – in other words, teamwork”.
LIFE NEWS
A NEW LIFE -
THANKS TO
A ROBOTIC BY-PASS 40 year-old Serkan Karababa was back on his feet within 15 days after by-pass surgery achieved without stopping his heart and without using scalpels, with three tiny holes in the armpit area and a single 4 centimeter incision under a rib bone.
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ERKAN KARABABA (40), a lifelong sports devotee
who had always led a healthy life and taken care of his diet, was admitted as an emergency case one morning after suffering severe chest pain. Doctors quickly determined that two of his coronary veins were blocked 100%. The decision to insert medicated stents into the blocked vessels was made without delay, and it was confirmed that Serkan Karababa had undergone a heart attack during the procedure. Detailed tests revealed that there was a 90% narrowing in the main coronary vessels. It was decided that a by-pass was required. After two days in the intensive care unit, Mr. Karababa was monitored in his hospital room for a further period of one week. His health was then restored thanks to robotic by-pass surgery conducted by Liv Hospital specialists in Cardiovascular Surgery. Access to the patient’s heart was achieved by means of three holes opened in the armpit area and a four centimeter incision made directly under a rib bone; the surgery was completed without stopping the patient’s heart. A HYBRID APPROACH: MEDICATED STENT AND ROBOTIC BY-PASS Liv Hospital Specialist in Cardiovascular Surgery Assoc. Prof. Dr. Ahmet Özkara explained “We conducted the by-pass using the most important cardiac vessel, the chest artery. Patient comfort was maximized since we did not open the chest area or stop the heart, as is required in classic by-pass operations. The patient had a problem in both vessels. In what we call a hybrid approach, we first applied stents, then carried out the by-pass. WRIST ANGIOGRAM “During the course of the procedure we observed that there was a problem in a number of vessels, and that one of them was acutely blocked at that time. There was 100% blockage. A large part of the blockage was forming a clot. We removed the clot using a special device. We then inserted a medicated stent as a method of comprehensively treating the affected region,” re26
counts Liv Hospital Specialist in Cardiology Assoc, Prof. Dr. Alp Burak Çatakoğlu. ROBOTIC SURGERY In the words of Liv Hospital Specialist in Cardiovascular Surgery Op. Dr. Cenk İndelen, “Mr. Karababa, on whom we had carried out robotic surgery, had a blockage on a single vessel and had vascular structures appropriate for by-pass surgery. He gave his consent for the operation. Using robotic surgical techniques we successfully operated without opening the sternum, with a single four centimeter incision under his left breast and three one centimeter holes.”
SINGLE KEYHOLE HYSTERECTOMY WITH ROBOTIC SURGERY
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ECENTLY DIAGNOSED with breast cancer, Zeynep Bayrak is 41 years old. Since her tumor was hormonesensitive, doctors recommended that she undergo surgery for the removal of her uterus and ovaries. Breast cancer was then diagnosed; the disease had spread. Ms. Bayrak therefore initially underwent chemotherapy. Her ovaries were then removed using single keyhole robotic surgery techniques, by Assoc. Prof. Dr. Cem İyibozkurt.
ACCESS FROM THE NAVEL This kind of breast cancer surgery can be performed using open, laparoscopic or robotic techniques. Open surgery would have involved a large incision to the abdomen and a longer recovery period. Having undergone robotic surgery with a single keyhole incision, Zeynep Bayrak has now returned to
her regular life. Laparoscopic and robotic techniques involve what we know as the minimally invasive approach, with minimum incisions, using endoscopic methods. Laparoscopy is conducted by Assoc. Prof. Dr. Cem İyibozkurt’s own hands after sterilization of the camera and equipment; long procedures are therefore prone to shaking of the camera, and use of the devices can become challenging. But there is no shaking or vibration in robotic surgery; the procedure provides clear 3D images without any involuntary movements. COSMETIC ADVANTAGES Conventional laparoscopy and robotic operations require the opening of 3 – 4 holes. In single hole robotic surgery, the robot’s arms and the camera are inserted into the abdomen via a single
Assoc. Prof. Dr. A. CEM İYIBOZKURT Liv Hospital İstanbul Specialist in Gynecology and Childbirth
keyhole made in the navel; the entire surgical procedure is completed in this way. After completion of the surgery, the sutures remain inside the patient’s navel. This avoids any scarring. The uterus and ovaries are removed via the vaginal passage. The patient also benefits from the 3D imaging obtained for the surgeon using robotic techniques, as well as the fact that the surgeon maintains fine control over the entire intervention. While single hole robotic surgery may be more painstaking than conventional robotic surgery, it has clear cosmetic advantages.
Creating a new tongue from forearm tissue
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N SPITE OF multiple visits to doc-
tors, the white marks that had begun to appear in banker İnci Aksakal’s mouth 9 years before were never diagnosed, or else the condition was said to be a fungal condition. Finally coming to Liv Hospital ENT Specialist Prof. Dr. İsmet Aslan, Ms. Aksakal was diagnosed with cancer of the tongue. Stating that the advanced degree of the cancer required the removal of more than half of her tongue, Professor Aslan says “The removal of more than half of her tongue meant that she could neither speak nor eat. So we constructed a new tongue using tissue taken from her arm.” Professor Aslan explains how they removed the cancerous tongue and made a new one: “We transplanted skin and veins from her forearm to her mouth. She has now regained all function. She can move her tongue,
talk and swallow. He stresses “It is absolutely essential to seek medical attention in the event that you have any ulcerous wound in the mouth that doesn’t clear up within 2-3 weeks.” Ms. Aksakal recalls having to relearn how to eat and talk. “When I learned the extent of the cancer I was scared – frankly my only objective
was to survive. My greatest concern was my son. He is still just 9 years old so I was frightened what would happen if I could not bring him up. My tongue could have been saved if the disease had been diagnosed in time. Misdiagnosis had a severe impact on my life but I kept up the struggle. I recovered thanks to Prof. Dr. İsmet Aslan.”
LIFE NEWS
Prof. Dr. OKTAR ASOĞLU Liv Hospital İstanbul Specialist in General Surgery
THEY TOLD ME
Assoc. Prof. Dr. A. CEM İYIBOZKURT Liv Hospital İstanbul Specialist in Gyneocology and Obstetrics
“THERE’S NO POINT IN SURGERY” BUT…
Diagnosed late with cancer and told by her doctors that surgery would be pointless, Habibe Delikanlı was treated by Prof. Dr. Oktar Asoğlu and Ass. Prof. Dr. A. Cem İyibozkurt.
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abibe Delikanlı went to her doctor suffering from severe pain. Her doctors conducted examinations and tests and told the young woman she had no medical condition. 6 months passed and the young woman’s pain became unbearable. After several episodes of severe pain attacks, and having gone from one doctor to another, Habibe was eventually diagnosed with cervical cancer. But doctors advised that since the cancer had been diagnosed late, there was no point in surgery. After intensive chemotherapy, Delikanlı’s tumor was eventually eradicated. However, the symptoms returned a short time later and soon became a continuous and unbearable pain that proved impermeable to pain relief medication. Further tests revealed that the cancer had spread. Finding a surgical solution 28
seemed a risky proposition; doctors told Habibe Delikanlı that an operation was out of the question. However, a team headed by Liv Hospital Medical Director and Specialist in General Surgery Prof. Dr. Oktar Asoğlu and gynecologist Assoc. Prof. Dr. Cem İyibozkurt recently performed surgery on Delikanlı that has succeeded in eradicating the tumor. “The real success in these kinds of high-risk operations is seeing the patient get up and return home without complications, as much as the actual removal of the tumor,” explain the doctors. They go on to say that this success is down to teamwork, a culture of different medical disciplines working hand in hand for the patient’s wellbeing. The greatest happiness and satisfaction they get is seeing the patient going back home without problems.
BRAIN SURGERY –
NO LONGER ANYTHING TO FEAR! Facilitated by its accumulated body of experience and technology, Liv Hospital has an advanced capacity to perform brain surgery; fluorescenceguided procedures enable the removal of even difficult to access tumors.
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HE fluorescence-guided surgical method is a specific form of brain surgery. Tumors originating in the brain tissue, as well as tumors such as certain kinds of metastasis and lymphoma, are normally indistinguishable during surgery. Specifying that when the tumor location is deep within the brain, access requires additional intervention, Liv Hospital Istanbul Specialist in Brain and Neuro Surgery Prof. Dr. Talat Kırış emphasizes that any diversion from the access path carries the risk of damage to normal brain tissue. This problem is now overcome using fluorescence-guided surgery and navigation. Briefing us on the topic of brain tumors, Liv Hospital Istanbul Specialist in Brain and Neuro Surgery Prof. Dr. Mustafa Kemal Hamamcıoğlu goes on to explain that brain tumors, which remain one of the leading conditions treated by the Brain and Neuro Surgery Department, are generally classified as benign or malign.
GUIDED SURGERY This method is employed in treating malign brain tumors and lymphoma, as well as metastatic tumors. Prof. Dr. Talat Kırış states “during fluorescence-guided surgery, a medication is administered following opening of the skull. This medication has been used by ophthalmologists in ocular angiography procedures for many years. Adhering to the tumor, this medication shows up tumor tissue in the brain, distinguishing it from normal brain tissue by staining it yellow. Experienced surgeons can distinguish this tissue (which is normally white, just as normal brain tissue) under the microscope through its different coloration. Brain tissue appears more pink in tone while the tumor tissue has a yellowish hue”.
TUMOR DEPTH - A PROBLEM OF THE PAST As for the advantage of the fluorescenceguided method, chief among them is the fact that the tumor can be detected however deep it lies. After reaching the tumor within the brain, the yellow-marked sections are removed. The normal brain tissue
Prof. Dr. TALAT KIRIŞ Liv Hospital İstanbul Specialist in Brain and Neuro Surgery
Prof. Dr. MUSTAFA KEMAL HAMAMCIOĞLU Liv Hospital İstanbul Specialist in Brain and Neuro Surgery
can then be seen. This method allows the complete removal of the tumor and minimizes damage to brain tissue. Highlighting the role of computerized tomography (CT) and magnetic resonance imaging (MRI) in the clinical systemic and neurologic diagnostic examination of brain tumors, Professor Hamamcıoğlu explains “Additional examinations (such as EEG – brain electrolysis, PET-CT, brain angiography (DSA) and hormone tests) may be carried out according to the state of the tumor and the condition of the patient. More detailed diagnostic images can be achieved using MR spectroscopy, perfusion MR, functional MR and MR tractography, advanced MR techniques that have been introduced in recent years.
“THE AIM IS TO REMOVE ALL POSSIBLE TUMOR TISSUE” Brain tumors are generally treated surgically. Just as diagnostic methods are able to give detailed data on the type, location and size of the tumor, definitive diagnosis can be achieved by means of pathologic laboratory analysis of the extracted tumor tissue. In this way, data can be obtained on issues such as tumor categorization, degree and the likelihood of recurrence. In the event that has grown to the extent that it is increasing pressure within the head, surgery should be carried out urgently or at least within the shortest possible time. Today, surgery is performed at the microscopic level using minimally invasive techniques and advanced technologies (navigation systems, tumor staining methods, intra-operative CT or MR, ultrasound etc.) The aim is to remove all possible tumor tissue. This is not always possible, in which case as much tumor tissue is removed as can be achieved without harming the patient. Additional treatments may be required according to postop pathologic diagnostic analysis. These are in the form of chemotherapy and radiotherapy, and are generally applied in malign tumor cases. Specialized focused radiotherapy procedures such as gamma-knife, cyber-knife and true-beam may be implemented in such cases, as well as being necessary in some benign mass cases.
LIFE CONCIERGE NEWS
LEISURE OPPORTUNITIES
YOU DESERVE A BREAK TOO The Liv Hospital Center for International Patients not only looks after our guests’ medical needs, but also understands that patients and their families or accompanying groups often wish to take a little time to experience the extraordinary leisure, touristic and shopping opportunities of Istanbul, and Turkey as a whole.
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UR CENTER FOR International Patients team offers expert assistance in making arrangements tailored to the specific requirements of the patient and their family. Be it a half-day tour of the historic sites of Istanbul and the Bosphorus, an excursion to some of Turkey’s other treasures, a guided shopping tour, or simply advice on the most appropriate leisure package tailored according to the client’s particular needs and budget, the Center for International Patients is ready to help make our patients’ visit a stress-free and positive all-round experience.
☞SHOPPING MALLS ISTINYEPARK Istinye Park is a shopping center with a unique urban lifestyle environment where a grand circular arrival plaza sits 30
between an open-air lifestyle center and a glass-roofed indoor retail area. The most luxury and exclusive stores are located outside at the open-air lifestyle center. Istinye Park Brands’ Street, an open space designed as a city square, features many brands including Burberry, Gucci, Miu Miu and Louis Vuitton, and restaurants of various nations and cuisines. ZORLU CENTER Zorlu center presets an exclusive range of every kind of store including Apple, introducing the iconic cube store concept specific to New York in its first store in Turkey. The Mall is distinctive for its gourmet concept in which Eataly, Jamie’s Italian, Tom’s Kitchen and Morini which are introduced to Turkish markets for the first time.
and most historic districts. Wander through the old streets and you’ll find some curious sights, such as the Church of the Virgin Mary. Climb the steep hillside toward Galata Tower along the street named Yüksek Kaldırım to see some of the city’s fine old Frankish (European) houses, several of the city’s most historic synagogues, and of course the Galata Tower. ISTIKLAL AVENUE Every night, revellers pack Istiklal and its side streets to eat, drink and sing. For a truly Turkish experience, head to the ‘meyhanes’ and fish restaurants off Balik Pazari (Fish Market) on Nevizade Street, as well as its celebrated neighbour, Cicek Pasaji (Flower Passage). If you’ve got any energy left, there are a number of nightclubs which playing rock, hip hop, reggae, blues, jazz, salsa and Turkish pop music.
Zorlu Center Mall also offers an extraordinary movie experience with 14 movie theatres, 2 of them VIP theatres. Foreign films are always shown in the orginal language with Turkish subtitles..
☞VENUES GRAND BAZAAR The Grand Bazaar (Kapali Carsi) is one of the world’s largest covered markets, spread over 60 streets and containing over 3000 shops of jewelry, textiles, pottery, glazed tiles, bronze, leather and carpets. Its marvelous and totally restored labyrinthine structure is said to attract up to 400,000 people each day to the largest concentration of stores under one roof anywhere in the world. Many people visit the Grand Bazaar to marvel at its beautiful interior and mind-boggling array of shops. But, of course, there’s plenty to buy here too.. GALATA DISTRICT (KARAKÖY) Galata is among the city’s oldest
other mosques, it also comprises a tomb of the founder, a madrasah and a hospice. The design of the Sultan Ahmed Mosque is the culmination of two centuries of both Ottoman mosque and Byzantine church development.
☞ARTS & CULTURE ZORLU PERFORMING ARTS CENTER Zorlu Center PSM is a performing arts venue located at Zorlu Center. It is Europe’s largest and world’s third largest performing arts venue.Zorlu Center PSM showcases diverse artistic genres including Broadway and West End musicals, dance, classical, opera, jazz and the best pop artists. Zorlu Center PSM also presents world famous performance troupes and live performing artists.
☞HISTORICAL ATTRACTIONS TOPKAPI PALACE At the height of its existence as a royal residence, the palace was home to as many as 4,000 people. After the end of the Ottoman Empire in 1921, Topkapı Palace was transformed into Topkapi museum a museum of the imperial era.t. BASILICA CISTERN The Basilica Cistern (Yerebatan Sarnıcı) is Istanbul’s most unexpectedly romantic attraction. Constructed in the sixth century and then forgotten for centuries, this ancient underground waterway takes you along sparsely lit walkways that weave around 336 marble columns that rise 26 feet to support Byzantine arches and domes, from which water drips. BLUE MOSQUE (SULTANAHMET) The Blue Mosque is so named because of the intricate blue tiles that decorate the inside of the mosque. It was built between 1609 and 1616, during the rule of Ahmed I. Like many
SAKIP SABANCI MUSEUM Sabancı University’s Sakıp Sabancı Museum is located in Emirgan, above the Bosphorus. The exhibition areas of the museum opened to visitors in 2002; the technical level of the museum has reached international standards. Today Sabancı University Sakıp Sabancı Museum presents a versatile museological environment with its rich permanent collection and comprehensive temporary exhibitions.
CLINIC
IORT: INTRAOPERATIVE SINGLE DOSE RADIOTHERAPY
Thanks to IORT carried out during cancer surgery, there is no need for post-op external radiotherapy in eliminating tumors.
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ARGETED RESULTS are now achievable thanks to singledose IORT (INTRA OPERATIVE RADIOTHERAPY) carried out during surgery. There are three ways of administering radiotherapy (RT): externally from outside the body, brachytherapy (in contact with the body) or internally (from within the body during surgery). IORT is the name given to the last of these methods.
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What is the purpose of IORT? The internal organs such as the stomach, small intestines, kidney etc. have a much lower tolerance to the high radiation dosages required to eliminate tumors. Conventional therapy constitutes a dose of 45-55 Gy divided up and administered in blocks of 1.8 – 2 Gy. While lingering microscopic disease requires 60 Gy, the treatment dose for inoperable tumors easily exceeds the tolerance levels of organs
and other structures. The objective of IORT is to irradiate the tumor bed during surgery, either in the sub-clinical regions or in the surgical area in the precise location from where it proved unfeasible to remove the tumor. Microscopic disease is eliminated. Healthy organs and tissues are protected. The procedure is carried out in a single surgical session. Compare that to standard RT, which requires treatment for six weeks, five days a week.
Prof. Dr. OKTAR ASOĞLU Liv Hospital İstanbul Specialist in General Surgery
Is IORT widely used around the world?
What makes IORT so superior? A 10 Gy radiotherapy dose administered intra-operatively (during surgery) is biologically equivalent to an external dose of 70 – 80 Gy - a dosage that is simply too high to be given using normal (external) methods.
Can an IORT patient also receive external radiotherapy? The radiation boost directed by IORT at the tumor bed does not disrupt any external RT the patient may require; it increases the patient’s recovery capacity and reduces recurrence.
Can a patient who has already received the maximum dose of external RT receive IORT treatment? IORT is the sole option for certain patients who require RT due to recurrence of their cancer.
Is there much evidence to support IORT usage? The National Comprehensive Cancer Network (NCCN) is the recognized roadmap for cancer treatment throughout the world. The NCCN issued their latest IORT usage guidelines in 2014.
It is used in about 150 cancer centers, including highly respected US centers such as Mayo Clinic, Memorial Sloan Kettering Cancer Center, and MD Anderson Cancer Center. Whatever claims one makes for any form of cancer treatment, the equipment and technology that it employs is crucial. IORT is of particular benefit in recurring colorectal cancer cases. However, since recurrence surgery is so challenging and requires such a high degree of specialized training, this treatment can only be carried out at certain centers. Therefore IORT has a special function in the post-op period, rendering significant increases in survival rates.
What are the essential ingredients of successful IORT? The sine non qua is a highly accomplished surgical team. You can never make up for poor surgery with radiotherapy. Rather, RT increases the surgery’s potential and the chances of success. Especially in cases of recurring cancers, there is serious scientific evidence that when treatment is supplemented by IORT, patients have a much higher chance of a long life free of recurrence.
Specialist Dr. TAYFUN HANCILAR Liv Hospital İstanbul Specialist in Radiation Oncology
IORT allows dosages of radiation too high to be administered externally to be focused on a small area in a single 20-50 minute session. It saves patients from having to undergo 5-6 week treatment courses, especially in breast cancer cases. Patients suitable for IORT need to be carefully selected; it is of special benefit in small tumor cases in patients over the age of 50. It is also beneficial in high-risk abdominal cases in which high RT dosages that could not be safely applied externally are directed onto a highly focused area in a single session, using very small applicator devices to avoid healthy tissue. The advantage of this method is that all the healthy tissue is circumvented, allowing very high doses of radiation to be focused on the cancer without harming the area around the tumor.
YOUR BODY
ALL ABOUT SCOLIOSIS Defined as a sideways curvature of the spine in the chest and lumbar region, scoliosis manifests itself in the form of curvature of the back, asymmetric shoulder and lumbar curvature, and “rib hump” deformity.
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E QUIZZED Liv Hospital Specialist in Orthopedics and Traumatology Assoc. Prof. Dr. Çağatay Öztürk on key aspects of scoliosis.
What is scoliosis and what causes it? Scoliosis is a sideways rotational three dimensional curvature that occurs in the chest or lumbar regions of the spine. The spine involves both lateral curvature and vertebral rotation. When looked at from behind, the vertebrae in a normal healthy spine extend in a 34
straight line from top to bottom. In scoliosis cases, the vertebrae are displaced rightwards or leftwards while also rotating around their own axes. Curvatures may occur in a single region of the spine or in more than one region and in different directions. Scoliosis is actually a symptom, rather than a disease. There are a number of diseases that can cause scoliosis symptoms. While scoliosis may be evidenced whatever the cause of spinal pain, adolescent idiopathic scoliosis is the progressive scoliosis most commonly seen in adolescent children.
Studies have indicated that the main factor in forms of scoliosis that emerge in adolescents is genetic predisposition. The factors that underlie scoliosis are identifiable; in the event that it is then treated correctly, the condition can be reversed. Incorrect or inappropriate treatments may aggravate scoliosis and serve to turn it into a permanent structural condition.
Who is most affected by scoliosis and why does it occur? Can we self-diagnose scoliosis? At which point is treatment or surgery required? In congenital scoliosis, the vertebrae may remain joined together or form abnormally, while the child is still in the mother’s womb. Scoliosis most commonly emerges during adolescence; timely intervention is essential to avoid damage to the cardiac and respiratory systems as well as deformity in terms of physical appearance. People’s observation of their own body forms and their recognition of even the smallest abnormalities is essential in early diagnosis. The most important indications are unilateral frontwards bulging of the backbone, lumbar asymmetry, a rightwards or leftwards leaning imbalance of the body, an imbalanced shoulder line and a one-sided bone protuberance in the lumbar region. The factors that underlie scoliosis are identifiable; in the event that it is then treated correctly, the condition can be reversed. Incorrect or inappropriate treatments may aggravate scoliosis and turn it into a permanent structural condition. Treating structural scoliosis is more challenging. In cases of curvature in excess of 40 degrees and progressive cases, surgical treatment is essential.
Can scoliosis cause back pain, or lead to other problems? Our bodies do not always display clear and unambiguous symptoms of underlying difficulties. For example, the back pain that occurs so frequently in our society may be caused by spinal conditions. Yet there is a widespread view that back pain is caused by hernias. The fact that MRI scans reveal neck hernias or herniated discs in 50% of patients suffering from spinal pain means that there is widespread confusion of back pain and spinal pain. The development of spinal conditions such as scoliosis reduces patients’ quality of life as well as challenging their ability to sustain themselves in life.
Assoc. Prof. Dr. ÇAĞATAY ÖZTÜRK Liv Hospital İstanbul Specialist in Orthopedics and Traumatology
What should people in the initial stages of scoliosis do? Can the progress of scoliosis be halted? Early diagnosis is highly important in treating scoliosis. Early diagnosis can keep the degree of curvature under control and halt its deterioration. This allows patients to regain their health before the onset of pain and without the need for surgery. Nonetheless, it should be remembered that scoliosis may progress in spite of all measures that may be taken. The one thing that scoliosis patients really need to do is to keep the condition under the observation of a specialist from the very beginning. In some scoliosis cases the condition progresses whatever is done, leading to the need for surgical treatment. Scoliosis surgery is carried out with high rates of success. The back pain that occurs frequently in our society may be caused by spinal conditions. Yet there is a widespread view that back pain is caused by hernias. The one thing that scoliosis patients really need to do is to keep the condition under the observation of a specialist from the very beginning.
“ People’s observation of their own body forms and their recognition of even the smallest abnormalities is essential in early diagnosis.
CLINIC
CATARACT SURGERY
WITHOUT STITCHES
Cataract is a clouding of the lens inside the eye. Visual loss occurs because opacification of the lens. The only treatment for cataract is surgery. And could happen to everbody not regarding to the age.
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ATARACT IS A Latin word meaning waterfall. While still water is translucent waterfall is not translucent but white. Cataract as a medical term means clouding of the lens inside the eye. Visual loss occurs due opacification of the lens. Cataract may develop as a part of the ageing process, it may develop secondary to other pathologies such as trauma, diabetes, ocular inflammation, corticosteroid use or it may be inherited. Unrelated to the cause it progresses over time. Cataract gives the sufferer the impression of seeing through a misted glass or a veil. Liv Hospital Specialist in Eye Diseases Doç. Dr. Tuğrul Altan answers queries on cataract treatment.
SYMPTOMS Near sight, far sight (or both) deteriorate. Light may scatter and may cause deeply reduced vision with the light shining to the eye. Vision is especially reduced in low lighting conditions.In the most severe cases vision loss may reach to a level that only light and dark can be distinguished.
How Are Cataracts Treated? Cataracts are treated surgically. The 36
Assoc. Prof. Dr. TUĞRUL ALTAN Liv Hospital İstanbul Specialist in Ophthalmology
surgical intervention is planned following determination of the exact requirements of the eye using high technology devices to measure the lens, map the cornea, and conduct layered tomography scans. A process called phacoemulsification is used with or without laser technology to dissolve and eradicate the cataractaffected area with ultrasonic energy, leaving the thin, transparent bag of the opacified lens intact. An artificial lens is then inserted and fine tuning of the lens is carried out to ensure focused vision. The entire surgical procedure lasts around 15 minutes. No two eyes are the same; each case is unique when we consider the individual eye’s anatomy, cataract hardness, and other associated systemic issues, not to mention the most important factor of all - the patient’s compatibility with the surgical procedure. Such factors may prolong the duration of the intervention.
Are stitches applied to the eye? Since the incisions are so small, stitches are not usually required. Sometimes one or two stitches may be used at the incision site in order to ensure the integrity of the tissue and maximize the safety of the surgical procedure.
What does the post-operative period involve? The patient is free to return home the same day after surgery. We advise patients to sleep wearing a plastic protective device. We then monitor the patient with check-up tests the next day and 3 or 4 days after surgery. We carry out longterm evaluation 1 month after surgery. And we tell patients they can return to work 1 week after surgery.
Assoc. Prof. Dr. EMRULLAH TAŞINDI Liv Hospital İstanbul Specialist in Ophthalmology
PAINLESS, NEEDLE-FREE CATARACT SURGERY Assoc. Prof. Dr. Emrullah Taşındı, Femtosecond laser-assisted cataract surgery allows cataract sufferers a rapid return to normal life after a two-stage, painless procedure carried out using anesthetic eye drops. In femtosecond laser surgery, various parts of the procedure carried out by hand are computer-controlled. Therefore the surgery is easier and more comfortable for the patient and ensures pinpoint accurate results. This serves to minimize the occurrence of side effects or complications during surgery.
LASER-ASSISTED CATARACT SURGERY Femtosecond laser technology facilitates a two-stage laser and ultrasonic wave treatment that puts both patient and surgeon at ease. The procedure can also be used to free the patient from the need to wear glasses by safely implanting intraocular lenses for near and far sighted patients, or toric intraocular lenses to correct astigmatism. The cataract is safely and rapidly cleared using a standard phaco system after femtosecond laser fragmentation of the lens through a tiny round incision made by laser in the front of the lens. This combined phaco / femto laser surgical procedure reduces complications when compared to standard phaco operations. Femtosecond laser-assisted cataract techniques constitute a significant milestone in modern cataract surgery for both patients and physicians, in terms of offering a safe, controlled, and successful surgical solution to cataract issues.
CORNEA TRANSPLANTS - A BRAND NEW VIEW ON LIFE Popularly known as “Eye Transplants”, corneal transplantation’s main objective is to protect and preserve the patient’s own tissue by replacing corneas that are damaged or have lost their transparency.
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HE CORNEA, the transparent layer at the front of the eye, is the most important lens in the eye. Corneal transplantations are carried out when disease-related darkening or staining obstructs the functioning of this lens. Liv Hospital Specialist in Eye Diseases Prof. Dr. Vedat Kaya explains that cornea transplantation is not performed only as an optical correction, but in some cases as a cosmetic procedure in cases where the patient has lost his or her sight. Transplantation can be performed on all patients including children, although there are various differences in the case of procedures carried out on children. These procedures require even greater care, says Professor Kaya: “We do carry out corneal transplantations on children when it is necessary to do so; we prefer the use of more advanced techniques in cases where only the diseased area is to be replaced rather than the entire corneal layer. These operations are successfully carried out at Liv Hospital.”
WHERE DO THE CORNEAS COME FROM? The corneas for transplantation come from “cornea banks”. This is both a health and a legal obligation because in transplanting tissue it is also possible to transplant various diseases and risks. A strict procedure has to be followed in order to prevent such risks.
KEEPING THE PATIENT’S OWN TISSUE The most commonly preferred technique in corneal transplantation is replacement of the corneal tissue. This involves the replacement of all the corneal layers. However, in recent years techniques known as “lamellar corneal transplantation” or “lamellar keratoplasty” that consist of replacing only the diseased part of
“ Transplants are beneficial in keratoconus and cornea dystrophy cases, as well as in treating previous cornea infections and injuries.
Prof. Dr. VEDAT KAYA Liv Hospital İstanbul Specialist in Ophthalmology
the cornea have become more widespread on the grounds that a basic objective of medicine should be to protect and conserve the patient’s undamaged tissue whenever possible. The use of lasers has also increased over the past few years. Although it is not a very common procedure, in appropriate cases laser surgery is performed. General anesthesia are used in most cornea transplant operations although local anesthesia is preferred whenever possible. The duration of the operation varies between one and oneand-a-half hours, depending on the technique being applied.
WHAT ABOUT AFTER THE OPERATION? Post-op care, monitoring and follow-up is of critical importance. Professor Kaya explains that if the patient is from overseas, the Liv Hospital team is always in close contact with a doctor in the patient’s home country who is able to carry out the required follow-up care and monitoring. Stressing that patients need to have regular medical examinations and follow their course of medication carefully, Professor Kaya concludes “Patients need to be fully briefed about the possibility of rejection reactions, especially in the case of full-thickness corneal transplants. And the patient should go to the doctor in the event that they show symptoms such as mild pain or redness in the eye, or blurred vision.”
AND IF TISSUE REJECTION DEVELOPS…? There are international protocols with respect to patients who develop tissue rejection. The first step is to stop the reaction as soon as possible; then, a damage assessment is carried out to establish the extent of the harm caused by the reaction. If the patient has suffered severe damage, re-operation may be the best option.
ESTHETICS KLİNİK
s c i t e h t es
THIS WILL REJUVENATE YOU! Medical interventions and surgical procedures are carried out by our physicians and specialist estheticians under professional medical supervision. 38
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FTER A CERTAIN point in life, the body’s self-repair mechanism begins to slow down. Aware of the fact that environmental factors tend to speed up this process, most of us look to the cosmetics sector for a solution. Liv Hospital’s Esthetic Team of specialist doctors and estheticians are with you every step of the way towards achieving the appearance you desire.
PROCEDURES CARRIED OUT AT THE MEDICAL COSMETIC DEPARTMENT: BioCavitation: Not only is this method effective in treating localized fat as well as cellulite and body firming, it also achieves localized metric reduction to reshape the body structure. Following a preliminary ultrasound examination,
electroporation is carried out using an anti-cellulite or firming gel. Finally, lymphatic drainage accelerates the expulsion from the body of fat that has remained stored between cells.
Lymphatic Drainage (Pressotherapy™): Pressotherapy is effective in treating edematous cellulite in obesity cases and postnatal care. This therapy also helps to prevent the development of varicose veins. Edema is reduced after liposuction. The skin’s elasticity increases. It assists in preventing thrombosis in bedridden patients. As well as being used in detox treatments, it can be used successfully in conjunction with other slimming devices.
Tripolar Radiofrequency: This achieves a more youthful appearance by heating up the fibroblasts that generate the fibers that give the skin its elasticity, thus immediately firming the skin. Metabolic activity is accelerated by heating the fat cells while stored fatty acids are expelled from the body. This reduces fat, achieving localized slimming and a reduction in the appearance of cellulite.
Icoone: Following general skin therapy, Icoone successfully treats sagging in the inner and outer arms, baggy skin, and loose tissue; the results are visible from the very first session.
Passive gymnastics: This device delivers electro-stimulation to the skin and muscles. It clears the skin, firms muscles and revives metabolism and lymphatic circulation, helping to expel accumulated tissue fluid and water. It is use in treating cellulite. Laser epilation: Laser epilation is a tried and proven method using cold laser techniques to directly destroy the hair follicle without damaging the skin. As well as depilation, existing laser systems are used in non-ablative skin renewal, capillary, scar and surfacepigmented lesion treatments.
NOW IS THE TIME TO GET BEAUTIFUL! Men and women are paying more and more attention to maintaining a youthful and more beautiful appearance. For most of us, esthetic enhancement represents a step towards the desired renewal of our bodies, be it from a health or a cosmetic perspective. The most critical aspect of achieving the appearance and the outcome that you desire is to put yourself in safe and experienced hands. YOUR EYES – WINDOWS TO THE SOUL, REFLECTIONS OF BEAUTY Younger patients who seek eyelid surgery often suffer only from swelling under the eyes, without sagging lids or wrinkles. For these patients, the removal of fatty tissue under the eyes is a sufficient solution. Older patients often have more challenging esthetic issues; in addition to excessive fatty tissue under the eyes and herniation, patients also have cosmetic issues such as eyelid sagging, bags, wrinkles, crowbar-style lines at the edges of the eyes, falling eyebrows, forehead wrinkles and sagging. In evaluating these patients, the entire face needs to be analyzed and other esthetic interventions such as facelifts, brow lifts, laser applications and peeling, in addition to eyelid cosmetic procedures, are carried out accordingly. Eyelid surgery is not only carried out for cosmetic purposes. Sometimes, the extent of sagging in the upper lid is so extreme that it covers the pupil and obstructs the patient’s vision. In such cases eyelid surgery may be carried out even if the patient has no cosmetic issues. Eyelid surgery can be performed under local anesthetic without putting the patient to sleep. Mild sedation can also be administered if the patient wishes, and he or she may return home the same day. The procedure lasts one or two hours. Thin knotless surgical stitches are applied that are easily removed after four days. Exposure to sunlight should be avoided for 10 days. Since it is performed while the patient is conscious, complications are extremely rare.
FOOTNOTE COSMETIC CHECK-UP: Liv Hospital offers a comprehensive cosmetic check-up package to all individual and corporate guests from around the world: 1. Plastic Surgery Examination 2. Dermatology Examination 3. Diet Examination 4. Dental Examination 5. Hair Transplantation / Varicose Examination 6. Foot Healthcare
ESTHETICS
STEM CELLS CAN PUT THE GLOW BACK IN YOUR FACE With their ability to transform into the tissue in which they are placed, coupled with their capacity to regenerate and initiate renewal, stem cells are of critical importance for the body’s renewal process. Subcutaneous fatty tissue in which there is a high proportion of adult stem cells can be extracted using a special technique, and this can easily be used to obtain stem cells. Stem cell and stem cell enriched fat grafting is a preferred option especially for the face, neck, chest and the back of the hand. It is most frequently applied in procedures to the face and neck regions. Thanks to stem cells, the entire face and neck region can be given a healthier, more youthful and firmer appearance.
COSMETIC DENTAL DESIGN Dental Specialists Fırat Dağcıoğlu and Samiye Çelik of Liv Hospital’s Department of Dental and Oral Health, define cosmetic dentistry as aiming to harmonize the patient’s dental appearance with his or her overall facial appearance. Cosmetic dentistry takes into account a variety of factors including the individual’s facial type, lines, gender, skin tone and personality.
WHITENING: By removing plaque, tartar and stains on the surface of the teeth, whitening offers an excellent solution to patients who are not satisfied with the original color of their teeth.
BONDING: In cases such as broken tooth restorations or gap closures, the treatment allows the patient’s affected teeth to be restored to their original color.
LAMINATE VENEER APPLICATIONS: QUICK RESULTS THANKS TO ENDOSCOPIC SURGERY Used especially in forehead and brow lift procedures, this technique involves just three 2-centimeter incisions rather than long incisions along the length of the scalp, from which the skin of the forehead and the brows can easily be lifted with the assistance of an optic camera. Endoscopic surgery can also be used in appropriate cases to correct sagging in the face and neck regions. Abdominal wall repair can be performed to correct childbirth-related loosening of the wall. Excess skin can be eradicated during breast lift surgery without removing breast tissue. If there is an excess of breast tissue, it can be reduced to the desired extent by removing some of the tissue. If breast enhancement is required, silicone breast implants can be inserted during the breast lift procedure. Vertical mammoplasty, the greatest advance in breast reduction surgery in recent years, leaves no scar in the fold under the breast, and the procedure achieves technically highly successful outcomes. 40
These are porcelain layers with an average thickness of 0.3 mm, designed for people who are not happy with the color, shape or positioning of their teeth.
FULL PORCELAIN CROWNS: While crowns have traditionally been based on a metal substructure, today’s versions are prepared from full porcelain for a much more esthetically pleasing restoration. INLAY- ONLAY FILLINGS: When there is insufficient dental material to support a regular filling without the extent of damage that would justify a crown, inlay onlay fillings are the perfect solution.
ORTHODONTIC TREATMENT: Orthodontics is a specialized field of dentistry which deals with an improper bite that may result from tooth placement or alignment of the jaw. Orthodontic solutions achieve esthetic results by creating straight and aligned teeth and a properly aligned jaw. Liv Hospital uses state-of-the-art esthetic brackets, transparent plates and brackets placed on the rear-facing surfaces of the teeth (the lingual technique) for
a permanently esthetic appearance in adulthood.
COSMETIC GUM TREATMENTS: A genuinely esthetic dental appearance can only be achieved with healthy, esthetic gums. Excessive redness, swelling or the appearance of infection in the gums can be effectively remedied by means of plaque-removal and if necessary curettage (the removal of diseased tissue from the gums). Methods such as gum leveling may be used to treat patients with an excessively gummy smile, while recessive gums (gingival recession) may require the application of gum flaps.
THE TIME COMES WHEN OUR SKIN NEEDS REVIVING AND RENEWAL Liv Hospital Specialist in Dermatology Assoc. Prof. Dr. Gonca Gökdemir lists the most important skin renewal methods in dermatology as chemical skin peeling, mesotherapy, platelet rich plasma (PRP) injections, laser treatments and stem cell injections. Chemical peeling peels away the upper layer of skin to activate the skin’s natural repair mechanisms, stimulating production of moisturizing substances. Dermatologist Dr. Gonca Gökdemir explains that different chemical peeling agents are used depending on the color, structure and sensitivity of the skin. The treatment is generally applied in the winter and the skin should be protected from exposure to sunlight during the procedure. PRP treatment involves the injection of concentrated platelets obtained from the patient him or herself using a specially designed tube. “This method allows the patient to benefit from the growth factors secreted by these platelets, or clotting cells,” says Dr. Gökdemir. Stressing that skin renewal laser treatments are continuously improving with the application of new technology, Dr. Gökdemir points out that it is now possible to renew and rejuvenate the skin with laser and other light-source treatments. All these procedures are carried out without the need for general anesthetic while it is also possible to combine more than one procedure in one session.
CAN A BOTCHED HAIR TRANSPLANT BE CORRECTED? The number of patients complaining of botched hair transplantations has begun to increase greatly over the past few years. Procedures not carried out in the correct conditions by experienced experts are more likely to end with poor results. What makes for a successful hair transplant? Hair transplants depend on a number of parameters. The most important are an experienced doctor, first class conditions in the hospital, and excellent ancillary healthcare personnel. Apart from these parameters, a
number of other factors can play a role in determining the outcome. For example, details such as case planning, photo-archiving, carrying out a mini check-up, serum attachment, using FUE (follicular unit extraction) management, ensuring the channels conform to their original angle, and
the frontal hairline, all play a distinct part in the ultimate outcome.
So can a botched job be corrected? Yes it can. First, one needs to examine the patient. If the front hairline is too far forward, it should be taken back using special techniques. Then any multiple hair follicles that have been implanted at the wrong angle need to be removed with a FUE motor and replaced with single or dual follicle implants at the correct angle.
Will the patient notice the difference? The difference will be clear not only to the patient but also those around him. Because rather than looking like someone who has obviously had a hair transplant, he will now be a person with a new head of hair that looks perfectly natural.
How long does this procedure last? It depends on the number of follicles and the extent of the problem, but as a rule of thumb it lasts about one hour longer than a normal hair transplantation procedure.
Can the patient return to his normal life straight away? He can go back to work the next day. Since the FUE method is used, the recovery time is much shorter than the previous session.
CLINIC
ALL YOU EVER WANTED TO KNOW ABOUT RADIOLOGICAL EXAMINATIONS On-the-spot radiological tests play an important role in early diagnosis.
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O RADIOLOGICAL EXAMINATIONS are crucial in disease diagnosis… but do you know what these tests are all about, and what the benefits and drawbacks might be? We have all heard about how modern devices try to minimize the radiation patients are exposed to. But we still need answers to so many queries on the subject. Liv Hospital Radiology Department Assoc. Prof. Dr. Barış Bakır, and Specialists Assoc. Prof.
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Dr. Adem Uçar answer your questions on the subject.
What is radiological examination or testing? Radiological examination is an imaging method used by doctors to diagnose and treat medical conditions and diseases. Direct radiography, mammography, ultrasonography, computed tomography (CT), Magnetic Resonance Imaging (MRI) and digital subtraction
angiography (DSA) are the main forms of radiological testing, all of which are indispensible in both diagnosis and treatment.
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What is the purpose of direct radiography? What are the pros and cons of medicated and unmedicated versions? It’s the first rung of the ladder in modern radiological imaging methods. Direct radiography has great value
Assoc. Prof. Dr. BARIŞ BAKIR Liv Hospital İstanbul Specialist, Liv Hospital Radiology Department
because it delivers only a very small amount of radiation whilst giving critical diagnostic data and information. Information about the stomach and intestinal lumen that cannot be seen using direct X-rays can be obtained using medicated X-rays. They also play a key role in the evaluation of the kidneys and urinary tract.
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What is the difference between computed tomography (CT) and magnetic resonance imaging (MRI)? CT achieves a cross-sectional image of the area under examination using X-rays. It clearly shows the shape and location of the internal organs, soft tissue and bones. MRI is the most advanced and developed radiological medical testing method. MRI uses the body’s natural parameters (the protons in the hydrogen atoms located in the water molecules in fluids and tissues) to obtain images. MRI devices consist of apparatus that has a magnetic field strength of between 0.2 and 3 Tesla. CT works best in imaging bones, MRI soft tissue.
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Is it right to ask for CT or MRI without first having an X-ray film?
There are steps or gradations in radiological tests. In most cases, X-rays are taken as a first step. In the event that a problem arises with the X-ray or that it fails to reveal the patient’s clinical condition, more advanced CT or MRI screening is applied. In tests on some parts of the body in which X-rays are
Assoc. Prof. Dr. ADEM UÇAR Liv Hospital İstanbul Specialist, Liv Hospital Radiology Department
not effective (the brain for example), CT or MRI may be carried out without taking X-rays.
During radiological examinations we are exposed to rays. Are they harmful? Radiation is not involved in methods like MRI and ultrasound, so patients are not exposed. Yes, patients are exposed to a degree of radiation in other methods like direct X-rays, CT and digital subtraction angiography (DSA). The permitted amount of radiation is determined by the Turkish Atomic Energy Board and international bodies, and regularly monitored. Modern devices and equipment minimize the radiation to which patients are exposed. In our department we use advanced technologies that reduce radiation dosages.
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How frequently can someone undergo radiological examinations? This depends on the patient and their condition. While this is not an issue in non X-ray methods, in other techniques a decision is made based on the benefits and risks in each individual case.
“ Major institutions such as the American Radiology Association and the American Cancer Association recommend that all women over the age of 40 undergo annual mammography screening. and the American Cancer Association recommend that all women over the age of 40 undergo annual screening. Mammography is an imaging method that uses X-rays. Since it is applied to soft tissue, the dosage is very low. Modern advanced mammography equipment reduces exposure to radiation to a minimum.
When can ultrasound be used as a diagnostic tool?
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Tell us a little about mammography.
Breast cancer is the most common type of cancer in women. Mammography is the main screening method used in the early diagnosis of breast cancer. It is therefore a very important examination. Major institutions such as the American Radiology Association
Ultrasound is an imaging method that uses sound waves. Its value lies in its dynamic imaging method, without using X-rays. It plays an important role in abdominal screening, trauma cases, superficial soft tissue lesions, breast diseases, pregnancy and in the examination of blood vessels (Color Doppler Ultrasound).
CLINIC
TAKE GOOD CARE OF YOUR JOINTS WITH STEM CELL TREATMENTS Stem cell applications can enable your body to regenerate musculoskeletal system tissue.
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iv HOSPITAL Regenerative Medicine Stem Cell Production and Application Center is able to achieve successful outcomes in the orthopedic field from regenerative cells obtained from the patient’s own tissue. Erdal Karaöz explains that stem cell treatment is set to become the most significant method to benefit patients in the future. 44
SUCCESS IN ORTHOPEDICS Karaöz states that in line with longer life spans, we have changed lifestyles and lead more active lives. But our joints and ligaments haven’t changed accordingly, and there is very little chance that they will renew themselves of their own accord. Karaöz adds that “When our joints and cartilages get worn out, this can cause significant
FOOTNOTE WHO IS A CANDIDATE FOR ORTHOPEDIC DISORDER STEM CELL TREATMENT? • Patients between the ages of 15 and 55 • Individuals with a Body Mass Index below 30 • Individuals without anterior cruciate ligaments who have had their meniscus removed • Individuals with normal anatomic alignment
problems in a person’s life especially if you are a professional sportsperson. People can even stop going out altogether.” Stating that biological treatments have gained prominence in recent years, Karaöz mentions the increased use of methods like cartilage transplantation, meniscus transplantation and micro-break treatment. In the field of orthopedics today, biologic treatment can be successfully applied in cases of cartilage problems, tendon and muscle injury, joint degeneration, spinal problems and sports injuries. Erdal Karaöz explains that the method of obtaining mesenchymal stem cells to create new tissue is not limited to the field of orthopedics – work and research in the fields of eye surgery, plastic surgery, cardiology, urology, systemic diseases and now even cancer treatments have begun. “Stem cells can be obtained from fat tissue, muscle, and bone marrow within the hip,” says Karaöz, adding that the most important cells in orthopedics are obtained from the tissue known as the synovium within the knee. These cells are obtained in a biopsy and sent to the laboratory where they are either kept daily or kept for 4 to 6 weeks for culture procedures. These cells are then “trained” to reproduce to form cartilage. “You can either inject them into the joint, or, if there is no cartilage in the local region, you can paste them to the membrane, thus making new cartilage” he explains. Karaöz stresses that Liv Hospital’s technology combined with its stem cell laboratory will serve to shine a light on numerous developments.
DIABETIC FOOT WOUNDS
Prof. Dr. ERDAL KARAÖZ Head of Liv Hospital Istanbul Regenerative Medicine and Stem Cell Production Center
Foot wounds caused by diabetes, are treatable thanks to regenerative cells that are applied to the the surgical area.
LET YOUR BODY REGENERATE ITSELF Liv Hospital Regenerative Medicine and Stem Cell Production Center aims to permanently solve many unresponsive classic treatments by cooperating with every branch. Regenerative Medicine is used to treat unhealthy, dysfunctional cells and tissue by using biological products under legal and scientific procedures at the Regenerative Medicine and Stem Cell Production Center.
ISCHEMIC LIMB PROBLEMS Regenerative cells extracted from the patient are not only used in treating many diseases, but also create an oppurtunity for treating embolism. Usage of regenerative cells for wound closure and restoring cirulation, is emerging as a new and effective treatment technique.
BURNS Liv Hospital Regenerative Medicine and Stem Cell Production Center, applies regenerative cells to patients suffering from chronic tissue burns, aiming to provide and help achieve a healthy apperance.
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Prof. Dr. CENGIZ PATA Liv Hospital İstanbul Head of Gastroenterology Department
Dietician SERAP GÜZEL Liv Hospital İstanbul Specialist in Nutrition and Diet
NON-SURGICAL REFLUX TREATMENT The ‘stretta’ technique is a form of treating reflux with a problem-free minimally invasive procedure with successful, long-term outcomes.
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ASTROESOPHAGEAL REFLUX disease (GERD) is a chronic digestive disease in which stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). The backwash (reflux) irritates the lining of your esophagus and causes GERD. Reflux is actually a physiological event that occurs in everyone at certain periods every day. What concerns us are the symptoms that arise in GERD cases as a result of tissue changes to the esophagus, throat, lungs, mouth and teeth from stomach acid backwash. This is because stomach acid, bile and pepsin can lead to chronic infection and, over time, cellular changes in the mouth and teeth. Head of Liv Hospital Istanbul Gastroenterology Department Prof. Dr. Cengiz Pata briefs readers on the advantages of stretta, while Dietician Burcu Erdöl gives nutritional advice to reflux sufferers.
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SUITABLE CASES FOR STRETTA The ‘stretta technique’ delivers radiofrequency (RF) energy to the muscle between the stomach and esophagus, which remodels and improves the muscle tissue, resulting in improved barrier function and fewer reflux events. It is especially recommended in cases of younger patients when the valve opening is less than three centimeters. This method is straightforward and troublefree for the patient; since it has proven successful long-term results, it is implemented at Liv Hospital in appropriate cases. Stretta treats the underlying problem causing GERD without surgery, while RF energy has been used in the treatment of a number of conditions including heart arrhythmia and liver cysts for many years. GET YOUR REFLUX UNDER CONTROL Most reflux pain is caused by the food and
“ Reflux sufferers should refrain from eating for a period of two hours before going to bed, eat a small amount at each meal, and sleep on a high pillow.
drink that we consume. Medication is one treatment option, but medication alone without addressing nutritional issues will not cure the condition. Dietician Burcu erdöl lists the main things to avoid in preventing reflux as alcohol, coffee, cigarettes and tea: “Other things that are at least as harmful in increasing the incidence of reflux are chocolate, fizzy drinks, tomatoes, and acidic fruits such as lemons, oranges, mandarins and grapefruit. Spicy foods especially black pepper and other spices, mint, and fatty food are problematic, and since lactose can lead to digestive problems in many people, dairy and milk protein products should also be avoided in excess.”
Meat Consumption: lean minced meat, lean beef, skinless chicken breast, egg whites and fish are the healthiest options. Naturally they should not be fried in fat or oil, nor should you add oil after cooking. Even when food is not fried, protein sources such as fatty meat and full fat milk should be avoided. CEREALS: Choose low-fat grain products. The best options are whole wheat, rye and oat foodstuffs, corn bread, wheat, and rice products. Fatfree popcorn is fine. Reflux sufferers are advised to eat some bread at every meal. Bread minimizes the amount of acid and helps to prevent reflux by absorbing some of the free fluid in the stomach. Other Problem-Free Foodstuffs That Should Not Cause Reflux Pain Include: Apples, bananas, broccoli, cabbage, carrots, green beans, peas, skinless chicken, egg whites, fish, nonfat cream cheese, rice, corn bread, cereals, bran, and oatmeal.
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SURVIVING CHEMOTHERAPY AND are receiving chemotherapy RADIOTHERAPY Iforyou radiotherapy you should read on!
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HE TREATMENT IS more lıkely to be successful WHEN the patient is well briefed and prepared. Liv Hospital Specialist in Medical Oncology Dr. Meltem Topalgökçeli Selam, Specialist in Radiation Oncology Dr. Tayfun Hancılar and Specialist in Nutrition and Diet Burcu Erdöl shared their advice and tips on getting through chemotherapy and radiotherapy with Live readers.
POSITIVE THOUGHT FOR POSITIVE RESULTS IN CHEMOTHERAPY The key factors impacting the chemotherapy process are positive thought, nutrition and exercise. At the outset the patient needs to have confidence in his or her doctor, and believe they can defeat the disease. Specialist in Medical Oncology Dr. Meltem Topalgökçeli Selam tells Live magazine “The patient will not be able to get the most out of the treatment without eating well and giving the immune system 48
the support it needs. Exercise helps to keep the patient in touch with the world, and to energize the body with movement. We advise patients to walk for 15-30 minutes every day without wearing themselves out. Regular sleep and 8 hours of sleep a night is also important.”
SIDE EFFECTS AND POINTS TO NOTE Patients need to follow their physician’s advice on the side effects of chemotherapy. Something that seems insignificant like a mouth sore can have very severe consequences if not dealt with efficiently. Side effects such as nausea, vomiting, fever, mouth sores, diarrhea and constipation are quite common in chemotherapy and can impact on the patient’s quality of life. Simple complaints can lead to larger problems. In the event that the patient’s temperature rises above 38 degrees, (s)he should contact his or her doctor to get blood tests and, if necessary, antibiotic treatment.
DO YOU FEEL WORN OUT? Patients can feel fatigues and listless during treatment. In subsequent weeks this sometimes becomes more noticeable as the dosage is increased. This fatigue is an absolutely normal result of treatment and should not be interpreted as meaning the patient is not doing well. This symptom disappears as the treatment ends. Liv Hospital Specialist in Radiation Oncology Dr. Tayfun Hancılar explains that faced with tiredness or fatigue during the treatment process, patients should take care not to wear themselves out and set aside more time than usual for rest. He adds “You should avoid habits that tend to prevent sleep such as having caffeinated drinks in the evening, or eating late. Fatigue can develop due to the reduction of red blood cells during treatment. Your doctor might recommend iron tablets or blood transfusion. The fatigue ends with the conclusion of the treatment, if it recurs some months
Specialist Dr. MELTEM TOPALGÖKÇELI SELAM Liv Hospital İstanbul Specialist in Medical Oncology
later it could be related to the disease and you should speak to your doctor about it.”
RADIOTHERAPY AND SKINCARE The skin can react to radiotherapy in the areas where it is applied. The risk is greater in areas prone to continuous sweating like the armpits or groin region. You should take care to keep these areas as well aired as possible and to wear comfortable loose cotton clothes. You can take showers during the course of your treatment but you should avoid using any harsh or abrasive sponges, loofahs and the like; wash with warm water and a soft sponge and dry gently with a soft towel. You should also avoid any substances that might irritate the skin such as perfumed soaps, powders and deodorants, lotions and creams. Men are generally advised not to shave during the course of treatment although if necessary they may be allowed to use a shaving machine. Sensitive areas exposed to radiotherapy should be treated carefully, avoiding exposure to the sun, or in winter to cold weather and wind. Exposure to the sun should be avoided for a period of one year after the therapy ends; after that, you should always take care to use high protection factor sun lotions.
YOUR SEX LIFE AND RADIOTHERAPY Patients undergoing radiotherapy generally perceive themselves to have lost their attraction and
Specialist Dr. TAYFUN HANCILAR Liv Hospital İstanbul Specialist in Radiation Oncology
FOOTNOTE HOW SHOULD I BE EATING?
Radiotherapy and chemotherapy patients should take care to eat small amounts at frequent intervals. They should increase their intake of liquids. Instead of hot spicy foods it is better to eat soft food served at room temperature. Avoid fatty, spicy and fragranced foods. Choose soft, nutritious food that will not upset your digestive system. Do not drink and smoke. Patients whose bowels are overactive should avoid pulp-making foods such as green vegetables, fruit and bran. In case of diarrhea, stick to potatoes, rice porridge, lean boiled pasta, peeled apples, bananas, nonfat cheese and breadsticks. Fluids lost through a loose stomach should be replaced by drinking plenty of water. If the diarrhea continues you should go to your doctor. And you should take care not to have lunch for at least an hour each side of your radiotherapy session.
Dietician BURCU ERDÖL Liv Hospital İstanbul Specialist in Nutrition and Diet
avoid sexual relations. But with the exception of certain gynecologic cases, there is no reason why you should not enjoy sexual relations during the course of radiotherapy. Indeed if a lowered libido can be overcome (with the help of a trained psychiatrist if necessary), the continuation of sexual relations with your loved one can be a great boost to morale. A cancer patient can be sexually active and unless your doctor advises otherwise, you should carry on with your normal life.
WHAT ABOUT EATING? Radiotherapy / chemotherapy patients should eat small amounts at frequent intervals. Liquid intake should be increased. Soft easily consumed food should be eaten warm or at room temperature rather than fatty, spicy or strongly flavored food. You should keep to soft, nutritious food that will not upset your digestive system. Alcohol and tobacco should be avoided at all costs. If you experience excessive bowel movement, you should stick to potatoes, boiled rice, boiled pasta without oil, peeled apples, bananas, low fat cheese and breadsticks. If you have diarrhea make sure to replace the lost fluid with plenty of water; if the diarrhea continues you should tell your doctor without delay. You should have lunch an hour before or after your radiotherapy session.
IF YOU HAVE A SOUR OR METALLIC TASTE IN YOUR MOUTH;
IF YOUR WHITE BLOOD CELL COUNT FALLS AFTER CHEMOTHERAPY;
• Try chewing gum or sugar free lemon mints. • Add things like basil, pepper or spices like rosemary to your food to enhance the flavor as well as sauces like ketchup and mustard. • If you are having difficulty eating red meat, make sure to eat other protein sources. For example, legumes (dry beans, lentils, chickpeas, etc.), fish, eggs, chicken, turkey, milk, yogurt, buttermilk, or soya milk. •You can make fruit easier to eat by adding it to ice cream, yoghurt or milk drinks.
• Avoid eating raw food (lettuce, rocket, parsley etc.) while your white blood count is low, even if it is well washed. • Avoid unpasteurized milk and milk products such as cheese and yoghurt (even if the milk is boiled, turning it into yoghurt still needs bacteria) • Avoid foods containing uncooked or half cooked eggs, and shellfish. • Do not buy pre-cooked packaged food from unknown sources. • Cook frozen foods well.
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e r Kne o f t s A Fir ery in Surg y: Turke
sty a l p O MAK
HEALTH TO YOUR KNEES!
Being used for the first time in Turkey at Liv Hospital, MAKOplasty ushers in a new era in knee surgery. Thanks to its 3-D technology design, MAKOplasty will now be able to give you the best possible knee replacement suitable to your individual condition and needs.
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A ‘first’ in prosthetic surgery is becoming reality with MAKOplasty. Thanks to the application of new technologies, you receive exactly the right replacement you need, enabling you to walk, run and even to bend your knees fully with ease.
Assoc. Prof. Dr. UĞUR HAKLAR Liv Hospital İstanbul Specialist in Orthopedics and Traumatology
Ass. Prof. Dr. TANER BEKMEZCİ Liv Hospital İstanbul Specialist in Orthopedics and Traumatology
HE INTRODUCTION OF stateof-the-art MAKOplasty technology marks the start of a new era in knee replacement surgery. After receiving the most appropriate knee replacement with the assistance of 3-D MAKOplasty technology, patients can easily walk, run and bend their knees. Liv Hospital Specialist in Orthopedics and Traumatology Assoc. Prof. Dr. Uğur Haklar explains that Liv Hospital is the only center in Turkey implementing this new technology, and briefs readers on its area of application.
MAKOplasty is a new system. How can we trust it?
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Who is a good candidate for MAKOplasty? MAKOplasty can be applied to all patients who have worn out knee joint cartilage that continues to cause pain in spite of all attempts at treatment, and those who need knee replacement surgery because the condition of their knees is diminishing their level of physical activity and their quality of life.
Is MAKOplasty only applicable to knee replacement surgery? Right now the technique is only applied to knee replacement in Turkey. Hip replacement has been carried out partially using MAKOplasty, in the United States. We anticipate its use for hip replacements in about six months. It is then projected for use in shoulder and ankle replacement surgery. It may be possible to use the technique in a wider field, including tumor surgery and a number of orthopedic areas.
While it is brand new in Turkey, it has proved itself in use in the States and a number of other countries. MAKOplasty work began in America for the first time in 2004, receiving FDA approval for actual use on people in 2008. It was carried out on about one thousand people in 2009, receiving EU approval in 2010. It was used in about 10,000 procedures in 2011, while in 2013 about 25,000 people underwent knee replacement surgery using robotic Unicondylar MAKOplasty. Today there are 140 MAKO robotic devices in the United States used by about 700 surgeons. There are 2 devices in Italy, one in the UK. Germany has ordered four. In other words, after the US, Turkey is the number 3 country in the world in terms of MAKO usage.
Isn’t knee replacement a pretty drastic decision for someone suffering knee pain? Imagine that you suffer from knee pain, you have tried everything but with no result. You need knee replacement surgery. That is, part of your knee bone will be replaced with a prosthesis that you will aim to be using for many years to come. We say many years because every prosthesis has a limited lifespan. After MAKOplasty we aim for 15 years. One of the most important factors in determining the lifespan of a prosthesis can be an error of even a few millimeters in the placing of the prosthesis. Therefore we want the best prosthesis implanted using the
CLINIC best surgical technique. Our objective using MAKOplasty is the most accurate placing of all parts of the prosthetic knee and most importantly the ability to foresee the correct compatibility between all parts of the prosthesis and to actually implement the ideal plan with pinpoint accuracy. MAKOplasty reduces the margin of error to a minimum, ensuring knees that will last in comfort for an extended period of time.
and protects the cruciate ligaments. MAKOplasty is a unicondylar knee replacement with a kind of specially designed surface coating. MAKOplasty requires an even smaller bone incision than regular unicondylar surgery. The importance of the cruciate ligaments lies in their role (together with the assistance of numerous other tissues) in our perception of position, also called our sense of proprioception. Since it protects and retains these ligaments, MAKOplasty offers an outcome
Comfort is just as important as durability It is not only the lifespan of the replacement knee that matters; its comfort and ease of use is also crucial. People with MAKOplasty knee replacements feel better; they can bend their knees over long walks or even runs. We know that physical activity is important at all times of life but especially as we get older. Reduced activity can lead to weight-related diabetes, high blood pressure and cardiac problems. For these reasons the knee replacement’s significance is not restricted only to the knees themselves but to the health of the entire body.
FASTER AND PAIN-FREE RECOVERY
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REDUCED IMPLANT WEAR AND LOOSENING
REDUCED HOSPITALIZATION
HOW DOES MAKOPLASTY BENEFIT THE PATIENT? MAKOplasty Partial Knee Replacements are designed to eliminate joint degenerationrelated pain
What is the structure of the prosthesis? Using the most advanced technology, the structure of MAKOplasty knee replacements has important and distinctive advantages. There are two main types of knee replacement. The first and most common type is a total knee replacement involving the entire surface of the knee. The other, less common type is a ‘unicondylar’ replacement, or a partial knee replacement that only replaces the damaged or defective part of the knee. The most important difference between total and unicondylar knee replacements concerns the retention of the cross-ties in the knee (known as cruciate ligaments) and the extent of the bone incision. Unicondylar surgery involves less extensive bone incision
with improved positional perception and controlled usage. In addition, the knee replacement used in MAKOplasty has been designed according to the anatomic structure of the bone. A prosthesis in greater conformity with the physiology of the knee results in far superior knee mobility and movement. Robotic surgery allows the easy implantation of these specially designed replacements that is simply not feasible using other systems in use today.
YOU CAN BEND YOUR KNEES FULLY
REDUCED SCARRING AND IMPROVED COSMETIC APPEARANCE
GREATER FLEXIBILITY WHILE PROTECTING BONE AND TISSUE
ENABLING PARTIAL JOINT REPLACEMENTS
AFTER MAKOPLASTY knee replacement surgery you will be able to GO ON LONG WALKS and
BEND YOUR KNEES FULLY
FOOTNOTE WHAT IS MAKOPLASTY® TOTAL HIP ARTHROPLASTY?
STEPPING BACK TO HEALTH MAKOplasty surgical techniques have got Fatma Azar back on her feet after being confined to her home for years by painful arthritis on her knee caps. Having met Liv Hospital Specialist in Orthopedics and Traumatology Assoc. Prof. Dr. Uğur Haklar through a TV program, Azar recounts her story: “Before the operation I used to take pain killers five times a day, I couldn’t bend my knees and walked like a crab. Now I do everything for myself – I can run, swim and ride a bicycle.” A robotic surgery technique called MAKOplasty means instead of having to wait for total knee replacements, patients can now get back on their feet with partial replacements. Explaining that she was able to get up without assistance just four days after the operation, Azar goes on to say that she began pedaling and treadmill exercises 17 days after surgery. Fatma can now easily bend her knee to an angle of 130 degrees and is enjoying the pleasure of living under her own steam. Uğur Haklar tells us “Fatma Azar was admitted with severe pain in both knees. Most of the cartilage was worn out and the bones were rubbing against each other. She had difficulty in moving and could only walk a short distance. Doctors she consulted correctly told her that she would have to wait till the age of 60-65 for knee replacement surgery. But since we have MAKOplasty technology, we were able to give Fatma knee replacements without her having to wait. Her outer knee cartilage was normal. We applied MAKOplasty surgical techniques only to the inner cartilage that had worn down. The operation went well. She also managed the post-op physiotherapy programs at a good pace. She is thrilled to have regained her freedom.”
MAKOplasty® Total Hip Arthroplasty (THA), is a procedure known as total hip replacement that is supported by the RIO® Robotic Arm Interactive Orthopedic System Dr. Taner Bekmezci explains. This innovative solution was designed for patients who suffer from non-inflammatory or inflammatory degenerative joint disease. RIO® enables surgeons to achieve a new level of precision using the latest techniques in total hip replacement and is designed to restore patient mobility and active lifestyle. RIO® robotic arm technology provides your surgeon a patient-specific 3-D model to pre-plan your hip replacement. During the procedure, tactile, visual, auditory feedback, and real-time data assists your surgeon in preparing the hip joint and placing the implants in the desired orientation with more accuracy. If surgeon determines that you are a good candidate for the MAKOplasty® procedure, he or she will schedule a computed tomography (CT) scan of your hip one or two weeks prior to your surgery date. This is used to create your unique surgical plan for optimal implant placement.
Am I a candidate? Dr. Taner Bekmezci says, “If your symptoms aren’t responding to non-surgical solutions, or your pain can no longer be controlled by medication, you may be a candidate for MAKOplasty® Total Hip Arthroplasty. Only your surgeon can determine if MAKOplasty® Total Hip Replacement is right for you.”
A MAKOplasty® Total Hip Replacement candidate may experience the following: • Pain while putting weight on the affected hip • Limping to lessen the weight-bearing pressure on the affected hip • Pain that may radiate to the groin, lower back, or down the thigh to the knee • Hip pain or stiffness during walking or other impact activities • Failure to respond to non-surgical treatments or nomsteroidal antiinflammatory medication
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IF COLON CANCER RECURS… In colon cancer cases, good postop care is just as crucial as surgery, especially during the intensive care period.
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HE LARGE INTESTINE consists of two main parts known as the colon and the rectum, to which different treatment options and types apply. “We can reduce the incidence of local recurrence by carefully and correctly choosing which patients require pre-op radiation and medical treatment, as well as identifying the right surgical techniques for each individual patient,” explains Liv Hospital Specialist in General Surgery Prof. Dr. Oktar Asoğlu.
“AS Liv HOSPITAL, WE NEVER TAKE RISKS WITH PATIENTS” Prof. Dr. Oktar Asoğlu states that in some cases local recurrence in the colon can spread to the abdominal membrane and the abdomen. Asoğlu explains that apart from this 54
condition, known as peritoneal carcinomatosis, local recurrence of rectal cancer can also take place. “According to international statistics, there is a 5% – 30% incidence of local recurrence in rectal cancer cases” says Asoğlu, mentioning a personal incidence record of 3.6%. Stressing that surgery to treat local recurrence is highly challenging, Asoğlu goes on to state “The key thing is to prevent local recurrence. In the event of recurrence, the surgery required depends on the exact location to which the cancer has spread within the pelvis. In the case of recurrence throughout the bladder, the uterus, or in men where cancer has spread within or behind the prostate, radical surgery even to remove the coccyx may be required. If the cancer recurs in the side walls, surgery to remove the veins running right down to the legs may be
required. The average duration of such surgery is about 10 hours but it can last as long as 15-16 hours and require between 8 and 10 units of blood for transfusions – these are major operations.” In addition, Asoğlu emphasizes that Liv Hospital does not expose patients to risk in cases where there is a higher probability of complications developing. Detailing their success in discharging patients who had undergone 15-hour operations, Asoğlu continues “The underlying reason for this success is our culture and systematic practice of teamwork.” Stressing that good post-op care is just as crucial as surgery, especially during the intensive care period, Asoğlu continues “The average period of hospitalization in our hospital’s ICU is 3 days. We have not lost a single patient, partly because we carry out heated chemotherapy procedures in order to remove cancer cells that have spread to the abdomen. Due to the long duration of the operation, the extensive need for blood and blood products, the increased risk of organ failure related to the chemotherapy agents we use to clean the abdomen during surgery, not to mention other factors such as the age of the patient, chronic health conditions or secondary diseases, there is an increased risk of acute kidney damage and cardiac arrest. Around the world, statistics show a morbidity rate of 25-40% in these cases, whereas we have not encountered a single case in which we have lost a patient.”
SUCCESSFUL TREATMENT NEEDS GOOD TEAMWORK Oktar Asoğlu goes on to explain that in cases of recurrence of cancer in the colon, a process defined as peritoneal carcinomatosis, in which the cancer spreads to the abdominal membrane and other organs, requires treatment. Underlining the need for painstaking evaluation of these cases to decide upon a course of treatment bearing in mind also the patient’s age, condition and the existence of any associated or secondary diseases, Asoğlu states “We can achieve positive outcomes if we can entirely clean the cells visible in the abdomen and scrub the abdomen with heated chemotherapy.” Stressing that these kinds of operations require intensive teamwork, Asoğlu continues “One of the most critical criteria in these operations is deciding whether or not the
“ Successful treatment is all about nurturing a team consisting of specialists from different disciplines, all speaking the same language and sharing the same perspective.
Prof. Dr. OKTAR ASOĞLU Liv Hospital İstanbul Specialist in General Surgery
patient has the capacity to get through the procedure. This can be resolved through a preliminary multi-branch evaluation involving various medical fields of specialization including anesthesiology, surgery, cardiology and internal medicine. Evaluation of the patient’s pre-op abdominal tests and films is important in deciding whether the procedure is likely to be successful. This requires highly accurate analysis and interpretation of images by a combined team including specialists in fields such as nuclear medicine and radiology.” Asoğlu goes on to point out the importance of a highly experienced anesthesiologist throughout the course of such a long operation, to guard against respiratory, cardiac or kidney failure. “Successful treatment is all about nurturing a team consisting of specialists from different disciplines, all speaking the same language and sharing the same perspective,” says Asoğlu, who goes on to specify that only a few patients can benefit from this treatment. “The important thing is to identify candidates and save them from their condition. And to be able to do this, highly specialized and painstaking work, experience, and great teamwork, are essential.”
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REDUCE YOUR RISK OF BREAST CANCER
Breast cancer is the most frequently occurring of all cancers facing women, with one in eight women encountering the disease in their lifetime. But it is possible to protect yourself from breast cancer…
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IFESTYLE FACTORS that underlie the development of breast cancer are classified as controllable risk factors. Liv Hospital Breast Surgery Specialist Prof. Dr. Levhi Akın lists these factors as follows: “Overweight, improper diet, lack of exercise, excess alcohol consumption, tobacco use, postmenopausal hormone use, birth control pill use, exposure to light at night, D-vitamin deficiency, stress, and anxiety…” Liv Hospital Specialist in Reconstructive, Cosmetic and Plastic Surgery Surgeon Dr. Ümran İleri goes on to explain the prostheses available to women who have lost breasts to cancer.
WHEN SHOULD I BE EXAMINED? The starting age for clinical breast examination is 30. High risk groups should start being examined at 20. Prof. Akın specifies that mammography tests should be carried out annually from the age of at 40. These tests should start from the age of 30 if the patient has a strong family history of breast cancer or has received radiotherapy in the past. Patients whose examinations do not reveal any need for further investigation may be tested every two years instead of annually.
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KNOW YOUR BREAST CANCER RISK A two-pronged approach is used to assess the risk of breast cancer. First of all, women with a high genetic (mutation) predisposition to the disease are identified; they are advised to undergo official genetic testing. Second, those who do not fall into this category or who test negative in genetic mutation testing need to be tested to establish their risk of contracting breast cancer, after a certain period of time. Breast cancer risk assessment can be implemented by means of certain investigations and screening tests; women assessed as being at high risk are then advised of options including breast-conserving surgery and medical preventive measures, or kept under observation and monitoring. Pointing out that there a number of proven statistical models for individual and societal breast cancer risk assessment, Prof. Akın goes on to say “Women who should benefit from preventive strategies can be identified by accurate, personalized risk assessment methods.”
FOOTNOTE ELIMINATE RISK FACTORS!
• Have regular breast self-examinations, and an annual clinical breast examination, together with annual mammography and ultrasound scans if necessary. • Get rid of excess weight. • Adopt a healthy and appropriate diet. • Do regular exercise • Avoid excess alcohol consumption. • Give up smoking for good! • Avoid stress. • Don’t use postmenopausal hormones and choose protection methods other than birth control pills. Taking these measures will protect you against breast cancer.
Prof. Dr. LEVHI AKIN Liv Hospital İstanbul Specialist in Breast Surgery
“ Being overweight, improper diet, lack of exercise, excess alcohol consumption, tobacco use, postmenopausal hormone use, birth control pill use, exposure to light at night, vitamin-D deficiency, stress, and anxiety all increase the risk of breast cancer.
Op. Dr. ÜMRAN İLERİ Liv Hospital İstanbul Specialist in Plastic, Reconstructive and Cosmetic Surgery
KEEPING YOUR BREASTS In breast cancer treatment, the patient’s morale impacts her ability to survive. Many women hate to look in the mirror after they have had a breast removed, and find it hard to get back to their normal social life. That is why women are advised to have single-session breast reconstruction surgery after the removal of the breast(s), using their own tissue and prostheses to reconstruct their breast without having to go through the pain of feeling the loss of a breast. Liv Hospital Specialist in Reconstructive, Cosmetic and Plastic Surgery Surgeon Dr. Ümran İleri stresses that whereas these procedures used not to be generally advised because they had to be carried out over multiple sessions and caused the patient significant pain without always achieving the desired results, nowadays procedures used the patient’s own tissue to the largest extent possible with more convenient and surgically easier usage of prosthetics: “The cosmetic outcomes are far better and the patient does not have to go through a painful process.” If the other breast is at risk of cancer, its tissues can be cleansed so that both breasts are in the same condition. If the patient does not like this idea and the breast has sagged, advanced breast-lift procedures can be carried out. From the moment of diagnosis, general and cosmetic surgery solutions can be determined in consultation between the patient and her doctors. Since in this case tissue from the other breast has been removed, there is generally no need for chemotherapy or radiotherapy. Patients emerge from cosmetic surgery with the appearance that they desire, ready to get back to their normal lives.”
TEAM SPIRIT
Op. Dr. CENK İNDELEN Specialist in Cardiovascular Surgery Assoc. Prof. Dr. ALP BURAK ÇATAKOĞLU Specialist in Interventional Cardiology
Assoc. Prof. Dr. ENIS OĞUZ Head of the Cardiology Department
YOUR HEART IS IN SAFE HANDS WITH OUR CARDIAC TEAM
Liv Hospital’s Cardiac Team gains prominence implementing patient-specific treatment methods.
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iv HOSPITAL offers an unrivalled service with its state-of-the-art technology and a team that is highly experienced in its use. The specialist five-person team consists of the Head of the Cardiology Department Assoc. Prof. Dr. Enis Oğuz, Specialist in Interventional Cardiology Assoc. Prof. Dr. Alp Burak Çatakoğlu, Specialist in Cardiac Imaging Assoc. Prof. Dr. Yelda Tayyereci, and Specialists in Cardiovascular Surgery Prof. Dr. Ahmet Özkara and Surgeon Dr. Cenk İndelen – all of them highly accomplished in their individual fields. Working together as an integrated and dedicated team, these accomplished specialists come to joint decisions concerning the most appropriate treatment for each and every patient.
TEAM SPIRIT Assoc. Prof. Dr. Enis Oğuz explains that the 58
“ Every patient needs to be offered treatment options appropriate and specific to his or her case. This only adds to the importance of our Cardiac Team.”
team initially examines patients from the perspective of their own field of expertise, while in more complex cases they form a group to come to joint decisions about the correct from of treatment. Stating that they synergize their differing expertise and experience to come to a common decision on individual cases, Assoc. Prof. Dr. Alp Burak Çatakoğlu continues “If there are a number of possible options, we first discuss the least harmful and most beneficial treatment options amongst ourselves in order to be able to discuss them with the patient.” Çatakoğlu says there is rarely only one single option in cardiovascular disease treatment; the existence of the team contributes hugely to the process of presenting the patient with customized treatment options. Assoc. Prof. Dr. Yelda Tayyareci emphasizes the need for a multidisciplinary approach when she
Assoc. Prof. Dr. YELDA TAYYARECI Specialist in Cardiology
Prof. Dr. AHMET ÖZKARA Specialist in Cardiovascular Surgery
states “As we come to decisions on surgical or catheter treatment methods for each individual patient in our clinic, the process is based on the cardiac team’s evaluation meeting together as a council, with a view to carrying out the treatment that is best for the health and safety of the patient.”
STATE-OF-THE-ART LABORATORY Assoc. Prof. Dr. Enis Oğuz states that one of the cardiac team’s greatest assets is Liv Hospital’s electro-physiologic laboratory. The technology used in diagnosing and treating irregular heart rhythm can permanently eradicate arrhythmia using radio frequency waves. Pointing out that Liv Hospital can also perform 3-D mapping, Enis Oğuz explains that complex arrhythmia cases can also be successfully treated. In addition, triple-chamber pacemaker technology serves to correct heart failure. Assoc. Prof. Dr. Burak Çatakoğlu says that Liv Hospital’s angiography laboratory is the best equipped of its kind in Turkey, using the most advanced equipment and technology. Moreover, the Liv Hospital cardiac team are equipped and experienced in accessing coronary arteries for ultrasound examination and diagnosis, as well as in using advanced imaging equipment known as OCT (optical coherence tomography) for coronary arteries and coronary disease. Specifying that they are experienced in the use of the specialized FFR (fractionalized flow reserve) pressure guide wire that is of particular use in cases where the team find it hard to come to a definitive decision, Çatakoğlu states “We have the capacity to carry out this procedure simultaneously, as a supplement to angiography.” Assoc. Prof. Dr. Ahmet Özkara stresses that since the angiography laboratory is designed to work in cooperation with the surgeon, they are able to intervene jointly in emergency cases. He goes on to say that the laboratory is one of the features that sets Liv Hospital apart from other centers perhaps the most important single feature. Explaining that the intra-aortic balloon pump used to treat emergency cardiogenic shock patients is integrated into the angio laboratory, Çatakoğlu emphasizes Liv Hospital’s pride in having an outstandingly highly specified and reliable laboratory.
TEAM SPIRIT
“Thanks to our use of 4-D echocardiography, the surgeon is able to achieve real-sight quality imaging when he or she opens up the heart, especially in cases of holes in the heart and heart valve surgery,” says Assoc, Prof. Dr. Yelda Tayyareci. This allows the surgeon to know exactly what he or she is going to encounter when they open up the heart, before surgery commences. This gives surgeons the advantage of being able to design their surgical treatment in advance. Revealing that unlike other centers, Liv Hospital carries out pre-operational neck carotid artery Color Doppler screening on all heart surgery patients, Tayyareci states “Most centers only carry out this imaging test on patients at high risk of stroke, whereas we create a safer surgical environment by screening all our patients with Color Doppler imaging.”
“AT Liv, WE AIM TO MAKE A DIFFERENCE” “The cardiopulmonary by-pass machine now in use at Liv Hospital is currently the most advanced anywhere in the world” explains Surgeon Dr. Cenk İndelen. He also describes how valve, aneurism and congenital heart disease used to be treatable only with open heart surgery, with the patient connected to a heart-lung machine. İndelen explains that at Liv Hospital, coronary by-pass surgery is not only carried out using open heart surgery methods, but can also be treated with “beating heart surgery” without arresting the lungs. “Heart surgery is available all around the country now,” points out Assoc Prof. Dr. Ahmet Özkara, “so the important thing is to be distinctive – to make a difference.” And the most effective way to make a difference is to increase the number of arteries used, and improve survival rates. Explaining that they had not used any blood in their previous operations, Özkara goes on to say “Using no blood in heart surgery leads to more rapid recovery periods for our patients. Patients spend one day in the ICU and are discharged in 4 to 5 days. We aim to make a difference for Liv by making this a routine procedure.” 60
FOOTNOTE ELECTROPHYSIOLOGY AND CATHETER ABLATION
Rapidly developing over the past decade, this advanced medical technology has brought a permanent solution to many arrhythmia cases. Guided to the heart via the veins, special wires known as catheters map the heart’s electric conduction by recording the electrical impulses within the heart. This can detect the underlying cause of arrhythmia. Radiofrequency waves emitted from the tip of the catheter can restore electrical conduction to its regular state. This can permanently correct arrhythmia without the need for any medication at all.
FOOTNOTE HEART SURGERY WITHOUT BLOOD Using the so-called FAST TRACK protocol, the Liv Hospital Heart Surgery Clinic aims at the shortest intensive care period and rapid discharge by carrying out surgery without blood transfusions, or, in cases where this is not possible, using the least possible quantity of blood. In April, no transfusions were carried out during surgery; ICU stays were 1-6 days, with an average total period of hospitalization of just 5 days.
FOOTNOTE ANGIO VIA THE WRIST Liv Hospital’s Cardiac Catheterization Laboratory conducts coronary angiography and interventional procedures using the most advanced technology. These procedures are carried out by a physician with expertise in his or her particular field. Patients are able to return home just three hours after the wrist (radial) procedure. Since a coronary angiography is a major procedure, the patient may need to spend one full day and night at the hospital. Interventional procedures generally last between 90 and 120 minutes. Patients are able to return to their normal lives a very short time after the radial procedure.
THE BENEFITS OF ENDOSCOPIC SURGERY
Assoc. Prof. Dr. A. CEM İYIBOZKURT Liv Hospital İstanbul Specialist in Gynecology and Childbirth
Endoscopic methods serve to increase patient comfort. They minimize pain while aiding in more rapid recovery.
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iv HOSPITAL Specialist in Gynecology and Childbirth Assoc. Prof. Dr. A. Cem İyibozkurt shares his knowledge of the benefits of endoscopic surgery with Live readers. Endoscopic surgery is a method of inserting a tiny camera and other devices into the body by means of entering through natural openings in the body or by making small incisions. The term ‘minimally invasive surgery’ has recently gained currency, this also being a form of surgery that uses small incisions to minimize the impact on the body rather than traditional open surgery. This technique makes use of high technology camera HD systems whereas in open surgery, there is a certain distance between the surgeon’s eyes and the tissue. Incisions are far fewer and smaller, thus minimizing pain and recovery periods.
A WIDE RANGE OF USES Endoscopic surgery has a wide range of obstetric applications. It is used in the removal of tumors from the uterus, treating benign cysts that develop in the ovaries and treating endometrial or “chocolate cysts”, diagnosing and treating ectopic pregnancies or diseases affecting the tubes (such as endometriosis or adhesions), the removal of the uterus,
“ Incisions made using endoscopic methods are much fewer and smaller than with open surgery, thus minimizing pain.
infertility assessment, and the surgical correction of conditions such as uterine prolapse and cancer of the female reproductive organs. Nearly all cases of uterine and cervical cancer can be treated using this method, as can most cases of cysts and masses that develop in the tubes and ovaries. It can be used in early stage ovarian cancer although it is less widely employed in the treatment of more advanced cases.
CLINIC
BREAKING THE
CANCER CODE:
TREATMENT GETS PERSONAL Scientific research is providing us with important information about the codes that determine the behavior of cancers. Knowing these features proves that the most appropriate treatment methods may differ, even between patients who have the same type of cancer.
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OUNTLESS RESEARCH studies have been conducted on tumor samples stored away over the past decade. This research shows that however much cancers may resemble one another, no two cases are really alike. Cancers’ different genetic characteristics also change the treatment trajectory. Specialist in Medical Oncology Prof. Dr. Haluk Onat explains to Live readers that the general approach known as “personalized medicine” has emerged from this understanding, and is now firmly on the agenda as the cancer treatment of the future.
TARGETED AGENTS Dr. Onat points out that these kinds of treatment have shown highly promising results even in previously untreatable cancer types such as myeloid leukemia and gastrointestinal stromal sarcoma. In this context, hope is progressively growing for more frequently occurring types of cancer like lung cancer, breast cancer
Prof. Dr. HALUK ONAT Liv Hospital İstanbul Medical Oncologist
“ Medications that act as targeted agents are projected to overcome the continuous proliferation of cancer cells.
and bowel cancer. Dr. Onat continues “This research has established that genetic changes are partly responsible for certain characteristics in these types of cancer, such as their ability to proliferate uncontrollably and spread rapidly, and their immortality”.
WHAT TYPES OF CANCER ARE SUSCEPTIBLE TO PERSONALIZED TREATMENT? Dr. Onat emphasizes that thanks to newly developed molecular methods, a turning point has been reached in the treatment of lung cancer, which is the most common and deadly form of cancer in our society. “Even if we have not yet found a cure with these treatments, we can now treat lung cancer patients who carry certain special genetic changes without chemotherapy for a period of one to one and a half years. And this period may be further extended in the case of other cancer types.” Anticipating the hopeful prospect that certain types of lung cancer that are difficult to treat today may also succumb to new treatment options in the future, Dr. Onat concludes on a triumphant note: “Our hope is to see the day in the very near future when we defeat cancer with the combined simultaneous use of a number of biologic medications targeting the same gene or different genes, instead of chemotherapy. Other types of cancers that we also personalized are colorectal cancer, malignant melanoma, thyroid cancer ,gastric cancer and soft tissue sarcomas”
CLINIC
BEFORE IT’S TOO LATE!
Without proper intervention, early stage head and neck cancers may have irreversible consequences. The objective of treatment at Liv Hospital, which is applied differently according to the location of the cancer, is to prevent loss of function in patients in line with their individual situation and requirements.
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EAD AND NECK cancers emerge in the most noticeable part of the human body. Although they are not as common as lung or breast cancers, the difficulties posed to patients and society give them a particular significance. Pointing out that one of the challenges in such cases is the visible nature of the condition in parts of the body that are hard to conceal, Liv Hospital Istanbul Specialist in ENT Diseases Prof. Dr. İsmet Aslan briefs readers on head and neck cancers while his colleague and Specialist in Radiation Oncology Dr. Tayfun Hancılar talks about radiotherapy in head and neck cancer cases.
PATIENTS FEEL EXCLUDED FROM SOCIETY The complete loss of the larynx as a result of a cancer originating in the head or neck region (eg. advanced stage cancer of the larynx), can result in a permanent hole in the patient’s lower neck area (tracheostoma) with associated lifelong loss of the patient’s voice and their capacity to express themselves. The coughing up of sputum from the lungs and 64
the inability to talk can lead to the patient’s exclusion from society and the onset of depression as the patient isolates him or herself from the wider world. These kinds of issues are not restricted just to cases of cancer of the larynx. Patients suffering from intraoral cancer of the jaw in which a tumor develops in the bone of the lower jaw (mandible) resulting in loss of almost the entire jaw, or paranasal sinus cancer in which the nose or half of the face is lost, or cancer of the tongue in which the entire tongue has to be removed, and who are therefore unable to talk or swallow, may also suffer from severe psychological problems. Other examples include patients who have lost the capacity to talk and swallow because of pharyngeal cancer, and who have to be fed through a tube, or patients who cannot talk as a result of cancer of the soft palate and have to be fed from the nose.
Prof. Dr. İSMET ASLAN Liv Hospital İstanbul Specialist in Ear Nose Throat
Specialist Dr. TAYFUN HANCILAR Liv Hospital İstanbul Specialist in Radiation Oncology
RATIONAL TREATMENT The loss of organs is often caused by patients delaying medical consultations as a result of their fear of head and neck cancer, even after symptoms emerge; this leads to profound physical and psychological issues. Yet this is an entirely baseless fear. Rational, multidisciplinary forms of treatment implemented in parallel by Liv Hospital’s ENT, Head & Neck Surgery, and Radiation Oncology Departments offer successful treatments in head and neck cancer cases. For example, 83% of laryngeal cancer cases can be successfully treated without the need for a tracheostoma, whatever the stage of the cancer. Likewise, thanks to developments in the field of ENT surgery, mouth cancer patients who lose most of their lower jaw are now able to receive bone transplantations from bones in the their leg, allowing the creation of a replacement jaw bone; a new tongue can now be formed using skin from the forearm, replacing the tongue that has been removed in cancer cases. Delaying treatment on account of fear of head and neck cancer is therefore a serious error, and based on an irrational fear.
RADIOTHERAPY FOR HEAD AND NECK CANCER As Specialist Dr. Tayfun Hancılar tells us, “There are a number of organs in the head
“ The three chief symptoms of head and neck cancers: hoarseness, sores in the mouth and swelling in the neck.
and neck region that have a significant impact on the person’s quality of life. In particular, it is now possible to ensure that patients do not subsequently from dryness of the mouth by protecting surrounding healthy tissue during radiotherapy in the head and neck region, especially the salivary glands, when using high doses of radiation. Dr. Hancılar goes on to explain the stateof-the-art techniques implemented at Liv Hospital: “We have begun to achieve highly successful outcomes using recently developed intensity modulated radiotherapy techniques and the daily CT (Cone Beam) monitoring capacity provided by Liv Hospital’s TrueBeam equipment. Thank to TrueBeam, the skin rashes and irritation that used to occur are more or less a thing of the past. The crucial criterion in the proper use of new technologies is to significantly increase the possibility of bringing the tumor under control as well as protecting healthy tissue as far as possible in order to minimize after-effects that can impact the patient’s quality of life.”
TEAM SPIRIT
THE SECRET ABOUT BEATING CANCER: IT’S ALL ABOUT TEAMWORK Just as all our organs need to work in synch for the body to function healthily, cancer treatment also needs harmony, with doctors and medical professionals working together as one synchronized team.
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LL SHARING A DRIVING passion for the health and wellbeing of the patients they serve, Liv Hospital’s doctors do not just work as individuals in their private rooms; they embrace a multidisciplinary approach, looking at each case in the same team spirit. However much we refer to distinct 66
“branches” in medicine, the success of each sub-branch rests on the ability to form synergies and embrace a spirit of teamwork towards the overall success of the whole. Liv Hospital Cancer Center has adopted the philosophy that the early diagnosis of cancer and the implementation of fast-developing
methods of treatment are best achieved through cooperation and teamwork across multiple fields of medicine; in this spirit they apply a patient-specific treatment approach with personalized cancer treatments. Liv Hospital Cancer Center serves patients through the close collaboration of specialists and physicians from many medical disciplines: General Surgery Specialist Prof. Dr. Oktar Asoğlu, Intensive Care Unit Specialist Prof. Dr. Simru Tuğrul, General Surgery Specialist Prof. Dr. Levhi Akın, Medical Oncology Specialist Dr. Meltem Topalgökçeli, Radiation Oncology Specialist Dr. Tayfun Hancılar, Nuclear Medicine Specialist Professor Dr. Levent Kabasakal, Nuclear Medicine Specialist Assoc. Prof. Dr. Handan Tokmak, Psychiatrist Dr. Berna Özen, Clinical Psychologist Dr. Beril Yardımcı, Nutrition
and Diet Expert Burcu Erdöl, Anesthesiology and Reanimation Specialist Prof. Dr. Didem Dal, Chest Diseases Specialist Prof. Dr. Ferah Ece, ENT Specialist Professor Dr. Nesil Keleş, Pathology Specialist Prof. Dr. Ümit İnce and his team, Specialist in Algology Assoc. Prof. Dr. Kader Keskinbora, Urology Specialist Assoc. Prof. Dr. Haluk Akpınar, Radiology Specialist Assoc. Prof. Dr. Barış Bakır, Radiology Specialist Assoc. Prof. Dr. Adem Uçar, Urology Specialist Assoc. Prof. Dr. Orhan Tanrıverdi, Endocrinology and Metabolic Diseases Specialist Assoc. Prof. Dr. Serpil Salman, General Surgery Specialist Ass. Assoc. Prof. Dr. Kürşat Serin, General Surgery Specialist Assoc. Prof. Dr. Fatih Tunca, Medical Genetics Specialist Assoc. Prof. Dr. Hakan Cangül, and Gastroenterology Specialist Assoc. Prof. Dr. Binnur Şimşek,
“ Screening tests are vitally important in the early diagnosis of cancer
TEAM SPIRIT Head of Gastroentology Prof. Dr. Cengiz Pata, Specialist in Gynecology and Obstetrics Assoc. Prof. Dr. A. Cem İyibozkurt.
TREATMENT STANDS A BETTER CHANCE WITH EARLY DETECTION With the combined forces of advanced treatment methods and effective teamwork, cancer is no longer the fatal disease that it used to be. Screening tests are of vital importance in the early diagnosis of cancer. The earlier the diagnosis, the higher the chances of successful treatment. Liv Hospital Cancer Center has adopted a patientspecific treatment approach with personalized cancer treatments. Screening tests carried out by specialists in the field of oncology detect cancer at an early stage, allowing effective treatment before the cancer can spread around the body.
CANCER DIAGNOSTIC METHODS Liv Hospital’s state-of-the-art technology and diagnostic equipment facilitates the detection of early stage cancer. Laboratory: Liv Hospital uses advanced laboratory technology in line with our patientoriented healthcare philosophy. PET/CT is an imaging technique formed from a combination of PET (Positron Emission Tomography) and CT (Computed Tomography). While PET provides data on cell function and metabolism, CT gives anatomic data such as
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“ Thanks to developing treatment methods and the best teamwork, cancer is no longer the terminal disease it used to be.
location and intensity. This plays an important role in determining staging and the type of treatment to be carried out (surgery / surgery + chemotherapy, radiotherapy, chemotherapy + radiotherapy etc.) Bronchoscopy: a process in which an endoscopic camera with a light at the tip is inserted directly into the respiratory tract for examinatory purposes. This method is used in the diagnosis of numerous lung diseases, and sometimes for their treatment. A flexible bronchoscope is generally used for diagnostic purposes. Liv Hospital’s experienced doctors perform the procedure by accessing the respiratory tract and airways via the mouth or nose. Gastroenterology: Endoscopic examinations and procedures are carried out at the Department of Gastroenterology with a view to maximizing patient comfort. Radiology: Liv Hospital Radiology Department employs high-tech equipment; at the same time these devices have the capacity and applications to carry out all advanced imaging methods. Fully equipped with the most advanced apparatus, the Radiology Clinic provides healthcare services guided by a multidisciplinary approach. The Department has a large magnet (70 cm), a 3-Tesla MRI device, 256-slice CT scanner, digital X-ray equipment, digital fluoroscopy equipment, mobile digital x-ray, digital mammography equipment, bone densitometry equipment, ultrasound and Doppler devices, and angiography equipment to guide neurologic and vascular interventions. Radiological tests are successfully used for the specialized diagnosis and treatment of medical conditions and diseases. With its effective interventional radiology techniques, the Liv Hospital Radiology Clinic can treat blood clots that risk causing strokes without the need for surgery. Thanks to this, and in cases where treatment is carried out on time, the risk of poststroke disability is reduced close to zero. In addition, brain aneurisms are treated at the Interventional Radiology Clinic without surgery, by access through the groin region. The patient is discharged straight after
the procedure. The width of the MRI device, which soothes patients with music and videos during the course of the procedure, makes our clinic the first choice for patients, especially overweight patients and those suffering from claustrophobia. Another key test, known as Tomographic Coronary Calcium Scoring, determines the patient’s future risk of cardiovascular disease. Genetics: Recent scientific advances have revealed the underlying causes of many hereditary diseases, as well as leading to significant developments in diagnosis and treatment. The Liv Hospital Regenerative Medicine Stem Cell Production and Application Center offers healthcare services in the areas of stem cells, clinical genetics, genetic counseling, cytogenetics, molecular cytogenetics, molecular genetics, and pre-implantation genetic diagnosis.
“ Liv Hospital Cancer Center offers the latest treatments based on an understanding of cancer behavior.
CANCER TREATMENT Thanks to personalized cancer treatments, Liv Hospital has embraced a patient-specific treatment approach. TrueBeamSTx: Oncology is the branch of medicine that specializes in research and applications in the treatment of cancer. Radiation oncology uses ionizing radiation as a form of cancer treatment. This method of treatment is generally referred to as radiotherapy. Recent technical (especially computer technology) advances used in parallel with the latest SCREENING AND PREVENTION
GROUP SUPPORT PROGRAMS
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DIAGNOSTIC METHODS
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10 HOME HEALTH9 CARE SERVICES
FOLLOWUP PROGRAMS
NUCLEAR
3 MEDICINE
EARLY DIAGNOSIS SAVES LIVES
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7 RADIOTHERAPY
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5 6 MEDICAL ONCOLOGY
CANCER SURGERY
TUMOR COUNCILS
radiotherapy devices have been highly successful in treating cancers of all kinds. The main principle of radiation treatment is to eradicate cancer cells or to prevent their multiplication. Radiation treatment carried out using advanced equipment with appropriate indications and applications represents a low-risk, high-benefit treatment model. HIPEC: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a form of heated chemotherapy directly applied to the abdominal cavity. It only penetrates directly into the cancer cells in the abdomen. This method allows the administration of higher dosage chemotherapy. The fact that the solution is heated increases absorption rates of the chemotherapy medication and eradicates microscopically sized cancer cells that remain in the abdomen after surgery. Before HIPEC treatment, doctors remove visible tumors using cytoreductive surgical procedures. Following the removal of tumors in this way, a heated, sterile chemotherapy solution is applied to the abdomen in order to remove the remaining cancer cells. The solution is heated to the temperature of a warm bath, 41-42 degrees C. It remains within the abdomen for an average period of about one and a half hours. The solution is then entirely evacuated and the incision closed. DaVinci Robotic Surgery: The most advanced of the third generation of robotic systems, the DaVinci System is recognized as one of the most significant of recent advances in surgery due to its ability to perform operations with the smallest possible incisions. The DaVinci robotic system has been increasingly used in gynecologic surgery over the past five years. Robotic surgery gives patients a series of advantages including small incisions, reduced intraoperative blood loss, reduced postop pain and a shorter period of hospitalization. In cases where benign or malignant masses are detected, robotic surgery as a sub-group of gynecologic surgery has become far more widespread over the past few years. Minimally Invasive Surgery: Popularly known as keyhole surgery, laparoscopic or minimally invasive surgery is a specialized form of surgery. Initially used in obstetrics and gynecology, laparoscopy began to expand into other areas including gall bladder, pancreas, liver, stomach and intestinal surgery, around the world. In traditional closed surgery, an incision running the entire length of the abdomen used to be required to access the stomach. With laparoscopic (keyhole) techniques, the operation can be completed with a few incisions just 0.5 – 1 centimeter in length.
YOUR BODY
DON’T GIVE IN TO OBESITY!
A sedentary lifestyle is an invitation to the scourge of our times, obesity. And of course one should also consider the psychological issues associated with being overweight. But there is a solution to obesity-related physical and psychological problems!
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BESITY SURGERY can be divided into two types: sleeve gastrectomy and gastric by-pass operations. Liv Hospital Specialist in General Surgery Assoc. Prof. Dr. Hasan Altun explains the latest methods and advantages of obesity surgery while Liv Hospital Specialist in Psychiatry Prof. Dr. Asena Akdemir addresses the psychological aspects of the condition.
SLEEVE GASTRECTOMY AND GASTRIC BY-PASS The sleeve gastrectomy is a method of restriction, or limiting the amount of food intake by reducing the size of the stomach. 75% of the stomach is re-
moved, while only a small stomach the shape of a tube remains. The gastric by-pass method involves both restriction and malabsorption, or limiting the absorption of foods in the intestinal tract by “bypassing” a portion of the small intestine.
KEYHOLE SURGERY Treatment methods have changed in line with advances in techniques and the experience of obesity surgeons. In all obesity operations, surgical entry is made via a single incision, or four or five incisions into the abdomen; keyhole surgery avoids opening up the stomach wall and may involve either laparoscopic or robotic surgical methods. Patients experience rapid weight loss in the first month while the entire postsurgery weight loss period is one to one and a half years, whatever the method used. Gastric sleeve patients generally lose up to 75% of their excess weight while the figure for gastric bypass patients is 80-85% within 18 months.
DISCHARGE WITHIN THREE DAYS Patients undergoing surgery are generally discharged within three days after their operation. In either method they are given a specific dietary regime consisting of a liquid diet for the first two weeks followed by a further two-week period of soft or puréed food; they may begin the consumption of solid food after one month. The only thing that patients need to take care about is that they should not drink water during consumption of solid foodstuffs, as well as half an hour before and after meals. Apart from this there is no specific issue they need to worry about. Since sleeve gastrectomy surgery does not involve any intestinal intervention, patients do not need to take significant vi70
tamin or mineral supplements. Gastric bypass patients need to take life-long vitamin and mineral supplements. The decision about which surgical method is most appropriate is made according to the patient’s condition and habits, and the physician’s assessment. The gastric by-pass method is preferred in cases when the patient has a tendency to consume sweet foodstuffs, suffers from diabetes, high blood pressure, high cholesterol or requires significant medication for these conditions. This method causes greater weight loss and offers a measure of protection against diseases such as diabetes. Since sleeve gastrectomy surgery only involves the stomach, it is a shorter procedure than other methods and does not require the patient to take life-long vitamin and mineral supplements. For these reasons it is the generally preferred method worldwide. In addition, it is possible for the patient to undergo subsequent gastric by-pass surgery if this is judged necessary at a later stage.
LIV HOSPITAL’S OBESITY TEAM AND SUCCESS RATES Patients who undergo frequent check-ups and monitoring after their operation enjoy more successful outcomes. The Liv Hospital obesity team is composed of a psychologist, general surgeon, endocrinologist, cardiologist and dietician. Many patients benefit greatly by being monitored by a dietician and psychologist, and from participating in group therapy.
Assoc. Prof. Dr. HASAN ALTUN Liv Hospital İstanbul Specialist in General Surgery
APPLYING FOR THERAPY Suffering fluctuating weight gain and loss with frequent dieting without addressing the underlying causes of your weight problem can be psychologically damaging. Liv Hospital Specialist in Psychiatry Prof. Dr. Asena Akdemir states that weight problems often have an underlying psychological cause: “Consulting a therapist to address the psychological aspects of your eating disorder is a good starting point,” she says. This kind of treatment requires cooperation between different fields of medical specialization; a properly constituted multidisciplinary course of therapy and treatment can prevent the problem from recurring. One should remember that some psychiatric disorders manifest themselves directly through weight problems. For example, binge eating disorder is a manifestation of atypical depression. These cases involve excessive food consumption. Some conditions may be associated with a reduction in movement – for example schizophrenia. This is also a condition that can cause weight gain. Some medications used in psychiatry can also increase appetite. For this reason you should discuss the side effects of any medication you are taking with your doctor. Medications cannot cause weight gain by themselves. But an increased appetite needs to be countered by an appropriate diet and an increase in daily physical activity. You will be able to minimize any side effects of medication by following your psychiatrist’s advice.
Prof. Dr. ASENA AKDEMIR Liv Hospital İstanbul Specialist in Psychiatry
HOW CAN I FIGHT OBESITY? The struggle against obesity can be a long one. You should never set yourself extreme or unrealistic targets. • Your priority goal should not be to reach your ideal body weight, but rather to develop healthy eating and behavioral habits. • Most eating and activity models are learned behaviors and can be changed. The ideal intervention program involves reorganization or correction of the environment that determines your behavior. • The process of changing behavior patterns needs to be done slowly and in small steps. Only when changes have begun to work successfully should fresh changes be instituted. • You should work on reviewing your eating patterns, changing a sedentary lifestyle, and increasing activity levels (use the stairs rather than the elevator!) • Obesity is a chronic condition; the results obtained from initial therapy or treatment may be limited. Intervention can be a continuous process. • Since dieting alone is not sufficient in treating obesity, eating disorders that drive people to excessive eating and various psychiatric issues should also be addressed. For these reasons a psychiatrist should be part of the treatment program.
LIV HOSPITAL CONTRACTED INSURANCE PLANS
INSURANCE COMPANIES
BUPA Global Cigna International Axa PPP Aetna Global International SOS Van Breda International Metlife Expatriate Benefits MSH International. HTH Worldwide Henner - GMC AGIS Medlink International Autovision International Medical Group QHM Blueshield Global Benefits Group Thomas Cook Overseas LTD. Medexa
ASSISTANCE COMPANIES
AID Assistance Marm Assistance Mentis International Prestige International Europ Assistance Coris Assistance Mondial Assistance Mapfre Assistencia Interpartner Assistance EGY Cross Assistance Mediline Group Chargecare International Global Voyager Assistance Eurocross Turkey Healthwatch Assistance
For further information: http://www.livhospital.com.tr/anlasmali-kurumlar
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